Organization
GRANT PARK DENTISTRY, PC
Active
Other names
Grant Park Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD R COCKRELL DDS (OWNER)
(503) 282-0521
Entity
Organization
Contact information
Practice address
3280 NE BROADWAY, PORTLAND, OR 97232
(503) 282-0521
(503) 282-1084
Mailing address
17000 RED HILL AVE, IRVINE, CA 92614-5626
(714) 845-8890
(949) 474-1495
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/27/2015
Last updated
03/27/2015
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