Organization
DOC GROK PC
Active
Other names
Blue Sky Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA ABDELNOUR (OFFICE MANAGER)
(503) 806-0662
Entity
Organization
Contact information
Practice address
354 W ADAMS ST, SISTERS, OR 97759
(541) 549-0973
Mailing address
PO BOX 901, SISTERS, OR 97759-0901
(541) 549-0973
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
OR
124Q00000X
Dental Hygienist
—
OR
126800000X
Dental Assistant
—
OR
Other
Enumeration date
02/11/2009
Last updated
10/14/2010
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