| Michael C Royse, Dmd, Llc | |
|
511 Sw 10th Ave Suite #810 Portland OR 97205-2732 | |
| (503) 223-3910 | |
| Not Available |
| Full Name | Michael C Royse, Dmd, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 511 Sw 10th Ave, Portland, Oregon |
| Authorized Official Name and Position | Michael Charles Royse (OWNER) |
| Authorized Official Contact | 5032233910 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael C Royse, Dmd, Llc 511 Sw 10th Ave Suite #810 Portland OR 97205-2732 Ph: (503) 223-3910 | Michael C Royse, Dmd, Llc 511 Sw 10th Ave Suite #810 Portland OR 97205-2732 Ph: (503) 223-3910 |
| NPI Number | 1063787166 |
|---|---|
| Provider Enumeration Date | 03/21/2012 |
| Last Update Date | 03/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063787166 | NPI | - | NPPES |
| 158909 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D6613 (Oregon) | Primary |
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