Organization
PORTLAND ORTHODONTIC GROUP, LLC
Active
Parent organization
PORTLAND ORTHODONTIC GROUP, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PORTLAND ORTHODONTIC GROUP, LLC
Authorized official
DR. JENNIFER CROWE DDS (MANAGING MEMBER/ORTHODONTIST)
(503) 289-1992
Entity
Organization
Contact information
Practice address
3332 N LOMBARD ST STE B, PORTLAND, OR 97217-1258
(503) 289-1992
Mailing address
3332 N LOMBARD ST STE B, PORTLAND, OR 97217-1258
(503) 289-1992
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
01/08/2021
Last updated
01/08/2021
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