Organization
MOLALLA FAMILY DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN CHRISTOPHER MCNEIL D.M.D. (PRESIDENT)
(503) 829-7677
Entity
Organization
Contact information
Practice address
128 ROSS ST, MOLALLA, OR 97038-9390
(503) 829-7677
Mailing address
128 ROSS ST, PO BOX 390, MOLALLA, OR 97038-9390
(503) 829-7677
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9142
OR
Other
Enumeration date
07/29/2008
Last updated
07/29/2008
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