Organization
JANTZEN BEACH MODERN DENTISTRY, PC
Active
Other names
Jantzen Beach Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD R COCKRELL D.M.D. (OWNER)
(503) 241-1800
Entity
Organization
Contact information
Practice address
12239 N CENTER AVE, PORTLAND, OR 97217-7806
(503) 241-1800
(503) 241-1807
Mailing address
17000 RED HILL AVE, IRVINE, CA 92614-5626
(714) 845-8890
(949) 474-1495
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/09/2013
Last updated
12/09/2013
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