Organization
GRESHAM DG LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (MANAGER)
(971) 708-9540
Entity
Organization
Contact information
Practice address
455 WEST POWELL BLVD, GRESHAM, OR 97030
(503) 661-9696
Mailing address
455 WEST POWELL BLVD, GRESHAM, OR 97030
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/26/2022
Last updated
05/26/2022
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