| Cornell Family Dental | |
|
12887 Nw Cornell Rd Ste A Portland OR 97229-5894 | |
| (503) 646-9687 | |
| (503) 619-0066 |
| Full Name | Cornell Family Dental |
|---|---|
| Speciality | Clinic/center |
| Location | 12887 Nw Cornell Rd, Portland, Oregon |
| Authorized Official Name and Position | Randall N Freed (OWNER/DENTIST) |
| Authorized Official Contact | 5036469687 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornell Family Dental 12887 Nw Cornell Rd Ste A Portland OR 97229-5894 Ph: (503) 646-9687 | Cornell Family Dental 12887 Nw Cornell Rd Ste A Portland OR 97229-5894 Ph: (503) 646-9687 |
| NPI Number | 1063726644 |
|---|---|
| Provider Enumeration Date | 08/05/2010 |
| Last Update Date | 08/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063726644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 5171 (Oregon) | Primary |
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