Individual
DR. GLEN M SHIMSHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
511 SW 10TH, #1008, PORTLAND, OR 97205
(503) 223-2442
(503) 223-9447
Mailing address
511 SW 10TH, #1008, PORTLAND, OR 97205
(503) 223-2442
(503) 223-9447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4978
OR
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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