Organization
MOUNTAINSIDE GENERAL DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LENORE SUPNET D.M.D. (DENTIST)
(503) 762-2525
Entity
Organization
Contact information
Practice address
3740 SE 122ND AVE, PORTLAND, OR 97236-3405
(503) 762-2525
(503) 762-4872
Mailing address
3740 SE 122ND AVE, PORTLAND, OR 97236-3405
(503) 762-2525
(503) 762-4872
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7895
OR
Other
Enumeration date
05/15/2008
Last updated
05/15/2008
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