Organization
PORTLAND CHILDREN'S DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID JACOB RAPHAEL DDS (CO-OWNER)
(503) 893-2889
Entity
Organization
Contact information
Practice address
2323 NW WESTOVER RD, PORTLAND, OR 97210-3524
(503) 893-2889
Mailing address
2323 NW WESTOVER RD, PORTLAND, OR 97210-3524
(503) 893-2889
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9732
OR
Other
Enumeration date
04/27/2014
Last updated
04/27/2014
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