| Life Bloom Dental Llc | |
|
11786 Sw Barnes Rd Ste 340 Portland OR 97225-5930 | |
| (503) 646-4600 | |
| Not Available |
| Full Name | Life Bloom Dental Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11786 Sw Barnes Rd Ste 340, Portland, Oregon |
| Authorized Official Name and Position | Daniel Cho (OWNER DENTIST) |
| Authorized Official Contact | 9712226511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Bloom Dental Llc 11786 Sw Barnes Rd Ste 340 Portland OR 97225-5930 Ph: (503) 646-4600 | Life Bloom Dental Llc 11786 Sw Barnes Rd Ste 340 Portland OR 97225-5930 Ph: (503) 646-4600 |
| NPI Number | 1821654146 |
|---|---|
| Provider Enumeration Date | 05/13/2019 |
| Last Update Date | 05/13/2019 |
| Medicare PECOS PAC ID | 1456775485 |
|---|---|
| Medicare Enrollment ID | O20200722003584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821654146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Daniel Cho |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1205277118 PECOS PAC ID: 5698056729 Enrollment ID: I20200723002365 |
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