Organization
WEST TABOR DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY AVRITT (OFFICE MANAGER)
(503) 232-8847
Entity
Organization
Contact information
Practice address
5043 SE HAWTHORNE BLVD, PORTLAND, OR 97215-3255
(503) 232-8847
(503) 232-6890
Mailing address
5043 SE HAWTHORNE BLVD, PORTLAND, OR 97215-3255
(503) 232-8847
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/09/2026
Last updated
01/12/2026
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