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Organization
ROOTS DENTAL BROADWAY LLC
Active
Organization
ROOTS DENTAL BROADWAY LLC
Active
Other names
NE Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (MANAGER)
(503) 234-7870
Entity
Organization
Contact information
Practice address
2525 NE BROADWAY ST STE 200, PORTLAND, OR 97232-3527
(503) 234-7870
Mailing address
2525 NE BROADWAY ST STE 200, PORTLAND, OR 97232-3527
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D10629
OR
Other
Enumeration date
12/08/2017
Last updated
12/08/2017
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