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Individual

ERIC THEODORE KRISS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
2730 SW MOODY AVE BLDG, PORTLAND, OR 97201-5042
(504) 494-8867
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3098
(503) 494-8211

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11357
OR
390200000X
Student in an Organized Health Care Education/Training Program
D11357
OR

Other

Enumeration date
04/21/2020
Last updated
06/15/2021
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