Organization
PAC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN S LEE DDS (PRESIDENT)
(503) 788-1415
Entity
Organization
Contact information
Practice address
2850 SE 82ND AVE, SUITE 8, PORTLAND, OR 97266-1599
(503) 788-1415
Mailing address
2850 SE 82ND AVE, SUITE 8, PORTLAND, OR 97266-1599
(503) 788-1415
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8646
OR
Other
Enumeration date
04/06/2007
Last updated
08/22/2020
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