Organization
ADVANCED DENTAL ARTS NW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL C TEASDALE DMD (OWNER/DENTIST)
(503) 235-0555
Entity
Organization
Contact information
Practice address
1316 SW 13TH AVE, PORTLAND, OR 97201
(503) 235-0555
(503) 224-5726
Mailing address
1316 SW 13TH AVE, PORTLAND, OR 97201
(503) 235-0555
(503) 224-5726
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5751
OR
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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