Organization
REVOLUTION DENTAL IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY HOUTMAN (OPERATIONS MANAGER)
(503) 777-3333
Entity
Organization
Contact information
Practice address
19017 BEAVERCREEK RD, OREGON CITY, OR 97045-9537
(503) 777-3333
Mailing address
19017 BEAVERCREEK RD, OREGON CITY, OR 97045-9537
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D9000
STATE LICENSE NUMBER
OR
Enumeration date
02/21/2023
Last updated
03/07/2023
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