Organization
MICHAEL C ROYSE, DMD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL CHARLES ROYSE DMD (OWNER)
(503) 223-3910
Entity
Organization
Contact information
Practice address
511 SW 10TH AVE, SUITE #810, PORTLAND, OR 97205-2732
(503) 223-3910
Mailing address
511 SW 10TH AVE, SUITE #810, PORTLAND, OR 97205-2732
(503) 223-3910
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D6613
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158909
—
OR
Enumeration date
03/21/2012
Last updated
03/21/2012
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