Organization
ROOTS DENTAL BROADWAY LLC
Active
Other names
NE Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SMITH DDS (MANAGER)
(503) 234-7870
Entity
Organization
Contact information
Practice address
2525 NE BROADWAY ST STE 200, PORTLAND, OR 97232-3527
(503) 234-7870
Mailing address
2525 NE BROADWAY ST STE 200, PORTLAND, OR 97232-3527
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D10629
OR
Other
Enumeration date
12/08/2017
Last updated
12/08/2017
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