Organization
LIFESMILE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS HICKS DMD (PRESIDENT)
(503) 644-5433
Entity
Organization
Contact information
Practice address
13305 NW CORNELL RD, SUITE A, PORTLAND, OR 97229-5817
(503) 644-5433
(503) 633-5436
Mailing address
13305 NW CORNELL RD, SUITE A, PORTLAND, OR 97229-5817
(503) 644-5433
(503) 633-5436
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7362
OR
Other
Enumeration date
09/15/2007
Last updated
09/15/2007
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