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Organization
DQCGM OF OREGON LLC
Active
Organization
DQCGM OF OREGON LLC
Active
Other names
GATEWAY DENTAL SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRIE EDMONDSON (SR MANAGER LICENSING & CREDENTIALIN)
(629) 999-5014
Entity
Organization
Contact information
Practice address
10535 NE GLISAN ST STE 100, PORTLAND, OR 97220-4076
(971) 229-8777
Mailing address
PO BOX 842674, LOS ANGELES, CA 90084-2674
(629) 999-5014
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
05/15/2025
Last updated
05/15/2025
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