| Lifesmile Dental Group | |
|
13305 Nw Cornell Rd Suite A Portland OR 97229-5817 | |
| (503) 644-5433 | |
| (503) 633-5436 |
| Full Name | Lifesmile Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 13305 Nw Cornell Rd, Portland, Oregon |
| Authorized Official Name and Position | Thomas Hicks (PRESIDENT) |
| Authorized Official Contact | 5036445433 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesmile Dental Group 13305 Nw Cornell Rd Suite A Portland OR 97229-5817 Ph: (503) 644-5433 | Lifesmile Dental Group 13305 Nw Cornell Rd Suite A Portland OR 97229-5817 Ph: (503) 644-5433 |
| NPI Number | 1144416959 |
|---|---|
| Provider Enumeration Date | 09/15/2007 |
| Last Update Date | 09/15/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144416959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D7362 (Oregon) | Primary |
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