Organization
EAST PORTLAND DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY M KELLER (OFFICE COORDINATOR)
(503) 255-2424
Entity
Organization
Contact information
Practice address
9 NE 120TH AVE, PORTLAND, OR 97220-2348
(503) 255-2424
(503) 253-0150
Mailing address
9 NE 120TH AVE, PORTLAND, OR 97220-2348
(503) 255-2424
(503) 253-0150
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
380578
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851458533
DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES
OR
Enumeration date
05/07/2007
Last updated
01/28/2016
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