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22250 S Salamo Rd West Linn OR 97068-7206 | |
| (503) 656-9331 | |
| (503) 656-9391 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 22250 S Salamo Rd, West Linn, Oregon |
| Authorized Official Name and Position | Mark W Montgomery (SECRETARY) |
| Authorized Official Contact | 5036569331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
22250 S Salamo Rd West Linn OR 97068-7206 Ph: (503) 656-9331 | 22250 S Salamo Rd West Linn OR 97068-7206 Ph: (503) 656-9331 |
| NPI Number | 1962650234 |
|---|---|
| Provider Enumeration Date | 08/28/2008 |
| Last Update Date | 08/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962650234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5678 (Oregon) | Primary |
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