Organization
LAURISSA CHAMPION DMD LLC
Active
Other names
Eastside Periodontics & Implantology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURISSA M CHAMPION DMD (OWNER)
(503) 954-1372
Entity
Organization
Contact information
Practice address
2824 NE WASCO ST, SUITE 230, PORTLAND, OR 97232-1772
(503) 954-1372
(503) 954-1392
Mailing address
2824 NE WASCO ST, SUITE 230, PORTLAND, OR 97232-1772
(503) 954-1372
(503) 954-1392
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D8555
OR
Other
Enumeration date
06/08/2012
Last updated
06/08/2012
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