Organization
THE FRIENDS OF CRESTON CHILDREN'S DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORA D MATTSEN (SECRETARY/TREASURER)
(503) 513-5010
Entity
Organization
Contact information
Practice address
4701 SE BUSH ST, PORTLAND, OR 97206-3283
(503) 916-5808
Mailing address
10505 SE 17TH AVE, MULTNOMAH DENTAL SOCIETY, MILWAUKIE, OR 97222-7475
(503) 513-5010
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
D5168
OR
Other
Enumeration date
03/01/2010
Last updated
03/01/2010
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