| Portland Children's Dentistry, Llc | |
|
2323 Nw Westover Rd Portland OR 97210-3524 | |
| (503) 893-2889 | |
| Not Available |
| Full Name | Portland Children's Dentistry, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2323 Nw Westover Rd, Portland, Oregon |
| Authorized Official Name and Position | David Jacob Raphael (CO-OWNER) |
| Authorized Official Contact | 5038932889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Children's Dentistry, Llc 2323 Nw Westover Rd Portland OR 97210-3524 Ph: (503) 893-2889 | Portland Children's Dentistry, Llc 2323 Nw Westover Rd Portland OR 97210-3524 Ph: (503) 893-2889 |
| NPI Number | 1225458441 |
|---|---|
| Provider Enumeration Date | 04/27/2014 |
| Last Update Date | 04/27/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225458441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D9732 (Oregon) | Primary |
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