| Pediatric Dentistry, Rc | |
|
2824 Ne Wasco St Suite 230 Portland OR 97232-1772 | |
| (503) 284-5678 | |
| Not Available |
| Full Name | Pediatric Dentistry, Rc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2824 Ne Wasco St, Portland, Oregon |
| Authorized Official Name and Position | Noel V Larsen (DENTIST/OWNER OF PRACTICE) |
| Authorized Official Contact | 5032845678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry, Rc 2824 Ne Wasco St Suite 230 Portland OR 97232-1772 Ph: (503) 284-5678 | Pediatric Dentistry, Rc 2824 Ne Wasco St Suite 230 Portland OR 97232-1772 Ph: (503) 284-5678 |
| NPI Number | 1720240427 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720240427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D6853 (Oregon) | Primary |
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