| Pediatric Dentistry Of Portland Llc | |
|
2811 Ne Wasco St Portland OR 97232-1771 | |
| (503) 284-5678 | |
| Not Available |
| Full Name | Pediatric Dentistry Of Portland Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2811 Ne Wasco St, Portland, Oregon |
| Authorized Official Name and Position | Noel Larsen (OWNER) |
| Authorized Official Contact | 5032845678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry Of Portland Llc 2811 Ne Wasco St Portland OR 97232-1771 Ph: () - | Pediatric Dentistry Of Portland Llc 2811 Ne Wasco St Portland OR 97232-1771 Ph: (503) 284-5678 |
| NPI Number | 1679924526 |
|---|---|
| Provider Enumeration Date | 06/22/2016 |
| Last Update Date | 06/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679924526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D6853 (Oregon) | Primary |
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