Organization
LAKE GROVE DENTAL
Active
Other names
Gordon L Wiltshire, Jr, DMD, PC, Lake Grove Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHERINE GW MAURER (OFFICE MANAGER)
(503) 636-3641
Entity
Organization
Contact information
Practice address
4055 MERCANTILE DR, SUITE 150, LAKE OSWEGO, OR 97035-2633
(503) 636-3641
(503) 765-5310
Mailing address
4055 MERCANTILE DR, SUITE 150, LAKE OSWEGO, OR 97035-2633
(503) 636-3641
(503) 765-5310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/12/2008
Last updated
08/05/2025
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