| Stoneridge Dentistry Llc | |
|
8642 Sw Main St # 230 Wilsonville OR 97070-6585 | |
| (503) 622-8211 | |
| (503) 684-1207 |
| Full Name | Stoneridge Dentistry Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 8642 Sw Main St # 230, Wilsonville, Oregon |
| Authorized Official Name and Position | Thomas Clark (BUSINESS OWNER/DENTIST) |
| Authorized Official Contact | 5036228211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stoneridge Dentistry Llc 8642 Sw Main St # 230 Wilsonville OR 97070-6585 Ph: (503) 622-8211 | Stoneridge Dentistry Llc 8642 Sw Main St # 230 Wilsonville OR 97070-6585 Ph: (503) 622-8211 |
| NPI Number | 1740561729 |
|---|---|
| Provider Enumeration Date | 09/02/2011 |
| Last Update Date | 09/02/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740561729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D9460 (Oregon) | Primary |
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