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Organization
WILLAMETTE DENTAL
Active
Organization
WILLAMETTE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELINA BUDREVICH (DENTAL HYGIENIST)
(503) 533-1755
Entity
Organization
Contact information
Practice address
17804 NW MARYLHURST DR, PORTLAND, OR 97229-7913
(503) 533-1755
Mailing address
4925 SW GRIFFITH DR, BEAVERTON, OR 97005-2923
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
H5086
OR
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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