Organization
CLOUD NINE RALEIGH PARK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN WASDEN (COO)
(208) 965-9415
Entity
Organization
Contact information
Practice address
8568 SW APPLE WAY, PORTLAND, OR 97225-1772
(503) 292-6773
Mailing address
624 3RD ST S, NAMPA, ID 83651-3840
(208) 965-9415
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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