Organization
PACIFIC DENTAL GROUP
Active
Other names
Pacific Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
RAVY YOUNG (OFFICE MANAGER)
(503) 286-3200
Entity
Organization
Contact information
Practice address
5707 N INTERSTATE AVE, PORTLAND, OR 97217-4606
(503) 286-3200
(503) 286-2033
Mailing address
5707 N INTERSTATE AVE, PORTLAND, OR 97217-4606
(503) 286-3200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215074927
—
OR
Enumeration date
01/12/2022
Last updated
01/12/2022
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