Organization
PRIME GERIATRIC DENTAL CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN T. OKI DMD (SECRETARY)
(503) 774-6355
Entity
Organization
Contact information
Practice address
11400 SE 37TH AVE, MILWAUKIE, OR 97222-5982
(503) 774-6355
(503) 659-6325
Mailing address
11400 SE 37TH AVE, MILWAUKIE, OR 97222-5982
(503) 774-6355
(503) 659-6325
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7017
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071332
—
OR
Enumeration date
05/28/2015
Last updated
05/28/2015
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