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833 Sw 11th Ave #300 Portland OR 97205-2117 | |
(503) 224-7815 | |
(503) 222-0029 |
Full Name | |
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Speciality | Dentist |
Location | 833 Sw 11th Ave, Portland, Oregon |
Authorized Official Name and Position | James A Krippaehne (OWNER) |
Authorized Official Contact | 5032247815 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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833 Sw 11th Ave #300 Portland OR 97205-2117 Ph: (503) 224-7815 | 833 Sw 11th Ave #300 Portland OR 97205-2117 Ph: (503) 224-7815 |
NPI Number | 1164569638 |
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Provider Enumeration Date | 01/31/2007 |
Last Update Date | 04/20/2008 |
Medicare PECOS PAC ID | 1355642794 |
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Medicare Enrollment ID | O20170509002363 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164569638 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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