Organization
PACIFIC DENTAL INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A SORENSEN D.M.D., PH.D (DIRECTOR)
(503) 639-5136
Entity
Organization
Contact information
Practice address
12750 SW 68TH AVE, PORTLAND, OR 97223-8596
(503) 639-5136
(503) 620-0187
Mailing address
12750 SW 68TH AVENUE, PORTLAND, OR 97223
(503) 639-5136
(503) 620-0187
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
D7165
OR
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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