Organization
PORTLAND MODERN DENTISTRY, PC
Active
Other names
Portland Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUSTIN TODD DDS (OWNER DENTIST)
(714) 845-8500
Entity
Organization
Contact information
Practice address
5175 NE MARTIN LUTHER KING BLVD STE 110, PORTLAND, OR 97211-3233
(503) 406-1108
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
(714) 845-8500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/05/2019
Last updated
03/09/2022
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