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4839 Ne 42nd Ave Portland OR 97218-1609 | |
| (503) 284-6469 | |
| (503) 288-0490 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4839 Ne 42nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Cornelius Gehred (PRESIDENT) |
| Authorized Official Contact | 5032846469 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4839 Ne 42nd Ave Portland OR 97218-1609 Ph: (503) 284-6469 | 4839 Ne 42nd Ave Portland OR 97218-1609 Ph: (503) 284-6469 |
| NPI Number | 1043528169 |
|---|---|
| Provider Enumeration Date | 09/23/2010 |
| Last Update Date | 09/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043528169 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9242 (Oregon) | Primary |
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