Individual
KEVIN REED PACKHAM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2403 SE MONROE ST, SUITE C, MILWAUKIE, OR 97222-7646
(503) 654-5995
(503) 653-0465
Mailing address
2403 SE MONROE ST, SUITE C, MILWAUKIE, OR 97222-7646
(503) 654-5995
(503) 653-0465
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7196
OR
Other
Enumeration date
09/12/2005
Last updated
07/08/2007
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