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Organization
ROOTS DENTAL STARK LLC
Active
Organization
ROOTS DENTAL STARK LLC
Active
Other names
Roots Dental
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (MANAGER)
(503) 912-2600
Entity
Organization
Contact information
Practice address
16338 SE STARK ST, PORTLAND, OR 97233-3958
(971) 294-1399
Mailing address
16338 SE STARK ST, PORTLAND, OR 97233-3958
(503) 912-2600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9728
OR
Other
Enumeration date
08/22/2018
Last updated
09/20/2019
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