| Russell Modern Dentistry, Pc | |
|
1710 Ne 122nd Ave Portland OR 97230-1939 | |
| (503) 295-2120 | |
| (503) 305-3342 |
| Full Name | Russell Modern Dentistry, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1710 Ne 122nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Sumeet S. Pandhoh (OWNER) |
| Authorized Official Contact | 5032952120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Modern Dentistry, Pc Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8890 | Russell Modern Dentistry, Pc 1710 Ne 122nd Ave Portland OR 97230-1939 Ph: (503) 295-2120 |
| NPI Number | 1063173466 |
|---|---|
| Provider Enumeration Date | 01/07/2022 |
| Last Update Date | 01/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063173466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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