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10163 Se Sunnyside Road Suite 414 Clackamas OR 97015 | |
| (503) 653-4079 | |
| (503) 653-9902 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 10163 Se Sunnyside Road, Clackamas, Oregon |
| Authorized Official Name and Position | Robert D. Grew (OWNER) |
| Authorized Official Contact | 5036534079 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10163 Se Sunnyside Road Suite 414 Clackamas OR 97015 Ph: (503) 653-4079 | 10163 Se Sunnyside Road Suite 414 Clackamas OR 97015 Ph: (503) 653-4079 |
| NPI Number | 1801216130 |
|---|---|
| Provider Enumeration Date | 04/25/2014 |
| Last Update Date | 04/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801216130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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