| Estacada Family Dental, Llc | |
|
630 N Broadway St Estacada OR 97023-8584 | |
| (503) 630-4218 | |
| Not Available |
| Full Name | Estacada Family Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 630 N Broadway St, Estacada, Oregon |
| Authorized Official Name and Position | Cornelius Gehred (PRESIDENT) |
| Authorized Official Contact | 5036304218 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Estacada Family Dental, Llc Po Box 929 Estacada OR 97023-0929 Ph: () - | Estacada Family Dental, Llc 630 N Broadway St Estacada OR 97023-8584 Ph: (503) 630-4218 |
| NPI Number | 1366059768 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 09/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366059768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |