Organization
BETHANY FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY WELIN (INSURANCE COORDINATOR)
(503) 617-7384
Entity
Organization
Contact information
Practice address
4732 NW BETHANY BLVD, STE G-2, PORTLAND, OR 97229-9410
(503) 617-7384
Mailing address
4732 NW BETHANY BLVD, STE G-2, PORTLAND, OR 97229-9410
(503) 617-7384
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6857
OR
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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