Organization
PEDIATRIC DENTISTRY OF PORTLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NOEL LARSEN DMD (OWNER)
(503) 284-5678
Entity
Organization
Contact information
Practice address
2811 NE WASCO ST, PORTLAND, OR 97232-1771
(503) 284-5678
Mailing address
2811 NE WASCO ST, PORTLAND, OR 97232-1771
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D6853
OR
Other
Enumeration date
06/22/2016
Last updated
06/22/2016
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