| Nw Implant Center Llc | |
|
1002 Ne 122nd Ave Portland OR 97230 | |
| (503) 922-2020 | |
| Not Available |
| Full Name | Nw Implant Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1002 Ne 122nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Tin Le (OWNER/DENTIST) |
| Authorized Official Contact | 5035444889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nw Implant Center Llc 1002 Ne 122nd Ave Portland OR 97230 Ph: (503) 922-2020 | Nw Implant Center Llc 1002 Ne 122nd Ave Portland OR 97230 Ph: (503) 922-2020 |
| NPI Number | 1861082638 |
|---|---|
| Provider Enumeration Date | 01/25/2021 |
| Last Update Date | 01/25/2021 |
| Medicare PECOS PAC ID | 0749627321 |
|---|---|
| Medicare Enrollment ID | O20240319000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861082638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Tin Minh Le |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1922299445 PECOS PAC ID: 9931543741 Enrollment ID: I20240220004525 |
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