| Sunnyside Dentistry For Children, P.c. | |
|
11411 Se Sunnyside Rd Suite 101 Clackamas OR 97015-5745 | |
| (503) 855-5100 | |
| (503) 826-5196 |
| Full Name | Sunnyside Dentistry For Children, P.c. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 11411 Se Sunnyside Rd, Clackamas, Oregon |
| Authorized Official Name and Position | David E Doyle, Jr (PRESIDENT) |
| Authorized Official Contact | 5038555100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunnyside Dentistry For Children, P.c. 11411 Se Sunnyside Rd Suite 101 Clackamas OR 97015-5713 Ph: (503) 855-5100 | Sunnyside Dentistry For Children, P.c. 11411 Se Sunnyside Rd Suite 101 Clackamas OR 97015-5745 Ph: (503) 855-5100 |
| NPI Number | 1104156959 |
|---|---|
| Provider Enumeration Date | 12/29/2009 |
| Last Update Date | 11/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104156959 | NPI | - | NPPES |
| 005996 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D6490 (Oregon) | Primary |
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