Organization
ROOTS DENTAL STARK LLC
Active
Other names
Roots Dental
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (MANAGER)
(503) 912-2600
Entity
Organization
Contact information
Practice address
16338 SE STARK ST, PORTLAND, OR 97233-3958
(971) 294-1399
Mailing address
16338 SE STARK ST, PORTLAND, OR 97233-3958
(503) 912-2600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9728
OR
Other
Enumeration date
08/22/2018
Last updated
09/20/2019
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