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3332 N Lombard St Ste C Portland OR 97217-1258 | |
| (503) 548-2006 | |
| (503) 548-2012 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 3332 N Lombard St Ste C, Portland, Oregon |
| Authorized Official Name and Position | Prashant Charugundla (ORAL & MAXILLOFACIAL SURGEON) |
| Authorized Official Contact | 5035482006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3332 N Lombard St Ste C Portland OR 97217-1258 Ph: (503) 548-2006 | 3332 N Lombard St Ste C Portland OR 97217-1258 Ph: (503) 548-2006 |
| NPI Number | 1205664844 |
|---|---|
| Provider Enumeration Date | 07/24/2024 |
| Last Update Date | 01/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205664844 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Kennedy Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3506 N Lombard St, Portland, OR 97217 Phone: 503-289-0230 Fax: 503-286-5055 | |
Hayden Family Dentistry Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 732 Sw 3rd Ave, Suite 202, Portland, OR 97204 Phone: 503-541-2580 | |
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