Organization
COOPER MOUNTAIN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BANU RAMKRISHNA DMD (OWNER DENTIST)
(503) 356-1078
Entity
Organization
Contact information
Practice address
11471 SW SCHOLLS FERRY RD, BEAVERTON, OR 97008-7168
(503) 356-1078
Mailing address
11471 SW SCHOLLS FERRY RD, BEAVERTON, OR 97008-7168
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8822
OR
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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