Organization
LIFE BLOOM DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL CHO DMD (OWNER DENTIST)
(971) 222-6511
Entity
Organization
Contact information
Practice address
11786 SW BARNES RD STE 340, PORTLAND, OR 97225-5930
(503) 646-4600
Mailing address
11786 SW BARNES RD STE 340, PORTLAND, OR 97225-5930
(503) 646-4600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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