| Wildwood Dental Llc | |
|
8225 N Lombard St Ste 103 Portland OR 97203-3784 | |
| (971) 413-0761 | |
| Not Available |
| Full Name | Wildwood Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 8225 N Lombard St Ste 103, Portland, Oregon |
| Authorized Official Name and Position | Ross Hart (DENTIST) |
| Authorized Official Contact | 9714130761 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildwood Dental Llc 8225 N Lombard St Ste 103 Portland OR 97203-3784 Ph: (971) 413-0761 | Wildwood Dental Llc 8225 N Lombard St Ste 103 Portland OR 97203-3784 Ph: (971) 413-0761 |
| NPI Number | 1598238065 |
|---|---|
| Provider Enumeration Date | 01/08/2019 |
| Last Update Date | 01/08/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598238065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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