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Organization
PORTLAND MODERN DENTISTRY, PC
Active
Organization
PORTLAND MODERN DENTISTRY, PC
Active
Other names
Portland Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUSTIN TODD DDS (OWNER DENTIST)
(714) 845-8500
Entity
Organization
Contact information
Practice address
5175 NE MARTIN LUTHER KING BLVD STE 110, PORTLAND, OR 97211-3233
(503) 406-1108
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
(714) 845-8500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/05/2019
Last updated
03/09/2022
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