Organization
BROOKSIDE DENTAL-CANBY, LLC
Active
Other names
Perman Family & Cosmetic Dentistry, Brookside Dental-Clackamas
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE LOPEZ (REGIONAL MANAGER)
(503) 914-8221
Entity
Organization
Contact information
Practice address
1514 SE 3RD CT, CANBY, OR 97013-4560
(503) 266-2033
(503) 468-5925
Mailing address
22400 SALAMO RD STE 102, WEST LINN, OR 97068-8269
(503) 723-8722
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376532291
NPI TYPE 1
OR
Enumeration date
06/14/2022
Last updated
06/14/2022
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