Organization
HERITAGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE JEAN CRANE (OFFICE MANAGER)
(503) 231-8228
Entity
Organization
Contact information
Practice address
4511 SE HAWTHORNE BLVD, SUITE 101, PORTLAND, OR 97215-3195
(503) 231-8228
(503) 231-5634
Mailing address
4511 SE HAWTHORNE BLVD, SUITE 101, PORTLAND, OR 97215-3195
(503) 231-8228
(503) 231-5634
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5651
OR
261QD0000X
Dental Clinic/Center
9096
OR
Other
Enumeration date
11/03/2011
Last updated
07/11/2013
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