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4074 Nw Saltzman Rd Ste 107 Portland OR 97229-2423 | |
| (503) 629-8005 | |
| (503) 629-9775 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4074 Nw Saltzman Rd Ste 107, Portland, Oregon |
| Authorized Official Name and Position | Andrew Lee Thompson (OWNER) |
| Authorized Official Contact | 5036298005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4074 Nw Saltzman Rd Ste 107 Portland OR 97229-2423 Ph: (503) 629-8005 | 4074 Nw Saltzman Rd Ste 107 Portland OR 97229-2423 Ph: (503) 629-8005 |
| NPI Number | 1487913083 |
|---|---|
| Provider Enumeration Date | 05/16/2012 |
| Last Update Date | 05/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487913083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D7612 (Oregon) | Primary |
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