Organization
CHRISTOPHER BRADY DMD LLC
Active
Other names
Advanced Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PAVEL IVANOVICH SARANCHUK (MANAGER/AUTHORIZED SIGNER)
(503) 902-4300
Entity
Organization
Contact information
Practice address
4707 NE 102ND AVE STE A, PORTLAND, OR 97220-3393
(971) 867-2956
Mailing address
4707 NE 102ND AVE STE A, PORTLAND, OR 97220-3393
(971) 867-2956
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D10185
OR
Other
Enumeration date
08/02/2018
Last updated
08/02/2018
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