Organization
NE 82ND AVENUE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH NICHOL (OFFICE MANAGER)
(503) 254-0897
Entity
Organization
Contact information
Practice address
2150 NE 82ND AVE, PORTLAND, OR 97220-5607
(503) 254-0897
(503) 254-0894
Mailing address
2150 NE 82ND AVE, PORTLAND, OR 97220-5607
(503) 254-0897
(503) 254-0894
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D8506
OR
261QD0000X
Dental Clinic/Center
D8961
OR
261QD0000X
Dental Clinic/Center
D9389
OR
Other
Enumeration date
08/24/2010
Last updated
08/24/2010
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