Organization
BEAVERTON ORTHODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN W. BLACK (PRESIDENT)
(503) 524-0524
Entity
Organization
Contact information
Practice address
14795 SW MURRAY SCHOLLS DR, STE 119, BEAVERTON, OR 97007-9713
(503) 524-0524
Mailing address
PO BOX 1891, LAKE OSWEGO, OR 97035-0612
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D6736
OR
Other
Enumeration date
07/12/2012
Last updated
07/12/2012
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