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1401 Se Morrison St Ste 120 Portland OR 97214-2777 | |
| (503) 477-9911 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1401 Se Morrison St Ste 120, Portland, Oregon |
| Authorized Official Name and Position | Dana Fox (MANAGER) |
| Authorized Official Contact | 5032235039 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1401 Se Morrison St Ste 120 Portland OR 97214-2777 Ph: (503) 477-9911 | 1401 Se Morrison St Ste 120 Portland OR 97214-2777 Ph: (503) 477-9911 |
| NPI Number | 1700374154 |
|---|---|
| Provider Enumeration Date | 05/01/2018 |
| Last Update Date | 05/01/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700374154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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