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1890 Ne 162nd Ave Portland OR 97230-5642 | |
| (503) 257-9836 | |
| (503) 257-3723 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1890 Ne 162nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Farid Bolouri (DENTAL DIRECTOR DENTIST) |
| Authorized Official Contact | 5032579836 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1890 Ne 162nd Ave Portland OR 97230-5642 Ph: (503) 257-9836 | 1890 Ne 162nd Ave Portland OR 97230-5642 Ph: (503) 257-9836 |
| NPI Number | 1518090323 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518090323 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Oregon) | Primary |
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