Organization
COLUMBIA PARK ORAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAN A KOONING DMD (PRESIDENT)
(503) 289-9621
Entity
Organization
Contact information
Practice address
3549 N LOMBARD, PORTLAND, OR 97217-5901
(503) 289-9621
(503) 289-2930
Mailing address
3549 N LOMBARD, PORTLAND, OR 97217-5901
(503) 289-9621
(503) 289-2930
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D6081
OR
Other
Enumeration date
07/10/2006
Last updated
08/22/2020
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