| Pacific Dental Institute | |
|
12750 Sw 68th Ave Portland OR 97223-8596 | |
| (503) 639-5136 | |
| (503) 620-0187 |
| Full Name | Pacific Dental Institute |
|---|---|
| Speciality | Dentist - Prosthodontics |
| Location | 12750 Sw 68th Ave, Portland, Oregon |
| Authorized Official Name and Position | John A Sorensen (DIRECTOR) |
| Authorized Official Contact | 5036395136 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Dental Institute 12750 Sw 68th Avenue Portland OR 97223 Ph: (503) 639-5136 | Pacific Dental Institute 12750 Sw 68th Ave Portland OR 97223-8596 Ph: (503) 639-5136 |
| NPI Number | 1619180007 |
|---|---|
| Provider Enumeration Date | 05/08/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619180007 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | D7165 (Oregon) | Primary |
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