Organization
WORLD OF SMILES, PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE STAFFORD DDS (DENTIST/OWNER)
(503) 626-9700
Entity
Organization
Contact information
Practice address
11790 SW BARNES RD STE 280, PORTLAND, OR 97225-5935
(503) 626-9700
(503) 626-9772
Mailing address
11790 SW BARNES RD STE 280, PORTLAND, OR 97225-5935
(503) 626-9700
(503) 626-9772
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D9074
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1604500
UNITED CONCORDIA
OR
05
—
218744
—
OR
Enumeration date
07/05/2011
Last updated
07/07/2011
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