Organization
STONERIDGE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS CLARK DMD (BUSINESS OWNER/DENTIST)
(503) 622-8211
Entity
Organization
Contact information
Practice address
8642 SW MAIN ST # 230, WILSONVILLE, OR 97070-6585
(503) 622-8211
(503) 684-1207
Mailing address
8642 SW MAIN ST # 230, WILSONVILLE, OR 97070-6585
(503) 622-8211
(503) 684-1207
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9460
OR
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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