Organization
PETTYGROVE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARMEL DUDLEY DORAN D.D.S. (DENTIST)
(503) 224-6317
Entity
Organization
Contact information
Practice address
2267 NW PETTYGROVE ST, PORTLAND, OR 97210-2760
(503) 224-6317
Mailing address
2267 NW PETTYGROVE ST, PORTLAND, OR 97210-2760
(503) 224-6317
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9708
OR
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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