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973 Nw Saltzman Rd Portland OR 97229-5647 | |
| (503) 644-7202 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 973 Nw Saltzman Rd, Portland, Oregon |
| Authorized Official Name and Position | Jeffrey Peter Dewey (PRESIDENT) |
| Authorized Official Contact | 5032659847 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3826 Se Liebe St Portland OR 97202-4034 Ph: (503) 265-9847 | 973 Nw Saltzman Rd Portland OR 97229-5647 Ph: (503) 644-7202 |
| NPI Number | 1982106407 |
|---|---|
| Provider Enumeration Date | 02/28/2018 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982106407 | NPI | - | NPPES |
| 1851455935 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D8706 (Oregon) | Primary |
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