Individual
RANDY HEATON REESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10102 NE GLISAN ST, PORTLAND, OR 97220-4456
(503) 257-5959
Mailing address
10102 NE GLISAN ST, PORTLAND, OR 97220-4456
(503) 257-5959
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D7045
OR
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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