# PEDIATRIC DENTISTRY, RC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720240427
- **Authorized official:** NOEL V LARSEN D.M.D (DENTIST/OWNER OF PRACTICE)
- **Authorized official phone:** (503) 284-5678

## Contact information

- **Practice address:** 2824 NE WASCO ST, SUITE 230, PORTLAND, OR 97232-1772
- **Practice address phone:** (503) 284-5678
- **Mailing address:** 2824 NE WASCO ST, SUITE 230, PORTLAND, OR 97232-1772
- **Mailing address phone:** (503) 284-5678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | D6853 | OR | Yes |

## Other

- **Enumeration date:** 06/25/2008
- **Last updated:** 06/25/2008