| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 3500 Ne Mlk, Portland, Oregon |
| Authorized Official Name and Position | Matthew Ryan Kathan (DENTIST OWNER) |
| Authorized Official Contact | 9715063407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5400 Ne Rodney Ave Portland OR 97211-2642 Ph: (971) 506-3407 | 3500 Ne Mlk Portland OR 97212-2093 Ph: (971) 506-3407 |
| NPI Number | 1639504715 |
|---|---|
| Provider Enumeration Date | 09/09/2013 |
| Last Update Date | 09/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639504715 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D9561 (Oregon) | Primary |
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