Organization
VISEH SUNDBERG DDS PC
Active
Other names
Sundberg Center for Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VISEH MOVAREKHI-SUNDBERG DDS (PRESIDENT)
(503) 546-9079
Entity
Organization
Contact information
Practice address
222 NW 10TH AVE, PORTLAND, OR 97209-3109
(503) 546-9079
(503) 546-5474
Mailing address
222 NW 10TH AVE, PORTLAND, OR 97209-3109
(503) 546-9079
(503) 546-5474
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7735
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7735
STATE BOARD OF DENTISTRY
OR
Enumeration date
12/18/2013
Last updated
12/18/2013
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