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Organization
ROOTS DENTAL GP LLC
Active
Organization
ROOTS DENTAL GP LLC
Active
Other names
Roots Dental
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (MANAGER)
(971) 294-1399
Entity
Organization
Contact information
Practice address
2111 NE 40TH AVE, PORTLAND, OR 97212-5406
(503) 284-2139
Mailing address
2111 NE 40TH AVE, PORTLAND, OR 97212-5406
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9728
OR
Other
Enumeration date
08/20/2018
Last updated
08/20/2018
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