Organization
ROOTS DENTAL GP LLC
Active
Other names
Roots Dental
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (MANAGER)
(971) 294-1399
Entity
Organization
Contact information
Practice address
2111 NE 40TH AVE, PORTLAND, OR 97212-5406
(503) 284-2139
Mailing address
2111 NE 40TH AVE, PORTLAND, OR 97212-5406
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9728
OR
Other
Enumeration date
08/20/2018
Last updated
08/20/2018
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