Organization
ROOTS DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (CEO)
(716) 601-9468
Entity
Organization
Contact information
Practice address
3620 SE POWELL BLVD # 200, PORTLAND, OR 97202-1880
(716) 601-9468
Mailing address
3620 SE POWELL BLVD # 200, PORTLAND, OR 97202-1880
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9728
OR
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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