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Organization
COLUMBIA SQUARE DENTAL LLC
Active
Organization
COLUMBIA SQUARE DENTAL LLC
Active
Other names
Green Apple Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE HT KANG DDS (DENTIST)
(503) 224-0588
Entity
Organization
Contact information
Practice address
1320 SW 2ND AVE, PORTLAND, OR 97201-5833
(503) 224-0133
(503) 224-4750
Mailing address
1320 SW 2ND AVE, PORTLAND, OR 97201-5833
(503) 224-0133
(503) 224-4750
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8506
OR
122300000X
Dentist
D9083
OR
122300000X
Dentist
D9163
OR
Other
Enumeration date
06/01/2009
Last updated
06/01/2009
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