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214 N Russell St Portland OR 97227-1620 | |
| (503) 494-6822 | |
| (503) 284-1398 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 214 N Russell St, Portland, Oregon |
| Authorized Official Name and Position | Joe E Robertson (PRESIDENT) |
| Authorized Official Contact | 5034948252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
214 N Russell St Portland OR 97227-1620 Ph: () - | 214 N Russell St Portland OR 97227-1620 Ph: (503) 494-6822 |
| NPI Number | 1396800330 |
|---|---|
| Provider Enumeration Date | 12/27/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396800330 | NPI | - | NPPES |
| 023965 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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