Organization
DQCGM OF OREGON LLC
Active
Other names
GATEWAY DENTAL SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRIE EDMONDSON (SR MANAGER LICENSING & CREDENTIALIN)
(629) 999-5014
Entity
Organization
Contact information
Practice address
10535 NE GLISAN ST STE 100, PORTLAND, OR 97220-4076
(971) 229-8777
Mailing address
PO BOX 842674, LOS ANGELES, CA 90084-2674
(629) 999-5014
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
05/15/2025
Last updated
05/15/2025
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