| Pettygrove Dental Llc | |
|
2267 Nw Pettygrove St Portland OR 97210-2760 | |
| (503) 224-6317 | |
| Not Available |
| Full Name | Pettygrove Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2267 Nw Pettygrove St, Portland, Oregon |
| Authorized Official Name and Position | Carmel Dudley Doran (DENTIST) |
| Authorized Official Contact | 5032246317 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pettygrove Dental Llc 2267 Nw Pettygrove St Portland OR 97210-2760 Ph: (503) 224-6317 | Pettygrove Dental Llc 2267 Nw Pettygrove St Portland OR 97210-2760 Ph: (503) 224-6317 |
| NPI Number | 1558801597 |
|---|---|
| Provider Enumeration Date | 02/23/2017 |
| Last Update Date | 02/23/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558801597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9708 (Oregon) | Primary |
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