Individual
DR. ROY CREAGER LUSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
948 NE 102ND AVE, SUITE 105, PORTLAND, OR 97220-4064
(503) 253-1109
Mailing address
1405 SE 115TH AVE, PORTLAND, OR 97216-3965
(503) 863-4048
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6360
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930943902
TAX ID
OR
Enumeration date
01/03/2007
Last updated
12/19/2012
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