Organization
VISEH SUNDBERG DDS PC
Active
Other names
Sundberg Center for Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN JON SUNDBERG MT (VICE PRESIDENT)
(503) 546-9079
Entity
Organization
Contact information
Practice address
222 NW 10TH AVE, PORTLAND, OR 97209-3109
(503) 546-9079
(503) 546-5474
Mailing address
222 NW 10TH AVE, PORTLAND, OR 97209-3109
(503) 546-9079
(503) 546-5474
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7735
OR
Other
Enumeration date
03/21/2012
Last updated
03/21/2012
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