| Portland Modern Dentistry | |
|
5175 Ne Martin Luther King Blvd Ste 110 Portland OR 97211-3233 | |
| (503) 406-1108 | |
| Not Available |
| Full Name | Portland Modern Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 5175 Ne Martin Luther King Blvd Ste 110, Portland, Oregon |
| Authorized Official Name and Position | Austin Todd (OWNER DENTIST) |
| Authorized Official Contact | 7148458500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Modern Dentistry Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8500 | Portland Modern Dentistry 5175 Ne Martin Luther King Blvd Ste 110 Portland OR 97211-3233 Ph: (503) 406-1108 |
| NPI Number | 1598223919 |
|---|---|
| Provider Enumeration Date | 03/05/2019 |
| Last Update Date | 03/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598223919 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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