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1904 Ne 45th Ave Portland OR 97213-1418 | |
| (503) 281-0866 | |
| (503) 281-0867 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1904 Ne 45th Ave, Portland, Oregon |
| Authorized Official Name and Position | John Harley Worthington (PRESIDENT) |
| Authorized Official Contact | 5032810866 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1904 Ne 45th Ave Portland OR 97213-1418 Ph: (503) 281-0866 | 1904 Ne 45th Ave Portland OR 97213-1418 Ph: (503) 281-0866 |
| NPI Number | 1003115676 |
|---|---|
| Provider Enumeration Date | 03/22/2011 |
| Last Update Date | 03/22/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003115676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D9182 (Oregon) | Primary |
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