Organization
TIMBER DENTAL EAST BURNSIDE
Active
Other names
Timber Dental East Burnside
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN BERG (BILLING COORDINATOR)
(503) 419-6288
Entity
Organization
Contact information
Practice address
1200 SE SANDY BLVD, PORTLAND, OR 97214-1347
(503) 419-6499
Mailing address
1200 SE SANDY BLVD, PORTLAND, OR 97214-1347
(503) 419-6499
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033404751
NPI
—
01
—
1144213802
NPI
—
01
—
1295143212
NPI
—
01
—
1639504715
NPI
—
01
—
1780605287
NPI
—
01
—
1821225442
NPI
—
01
—
1851845036
NPI
—
01
—
1952684169
NPI
—
Enumeration date
02/14/2019
Last updated
06/11/2019
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