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Organization
82ND DRIVE DENTAL CLINIC
Active
Organization
82ND DRIVE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY W CARPENTER DMD (OWNER/ DENTIST)
(503) 655-7250
Entity
Organization
Contact information
Practice address
15480 SE 82ND DR, CLACKAMAS, OR 97015-9633
(503) 655-7250
(503) 650-6375
Mailing address
PO BOX 446, CLACKAMAS, OR 97015-0446
(503) 655-7250
(503) 650-6375
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8618
OR
Other
Enumeration date
10/08/2014
Last updated
10/08/2014
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