Organization
DENTAL3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN KATHRYN KIRCHOFF (EXECUTIVE DIRECTOR)
(503) 810-6525
Entity
Organization
Contact information
Practice address
7420 SW HUNZIKER ST STE F, TIGARD, OR 97223-8242
(503) 521-7166
Mailing address
7420 SW HUNZIKER ST STE F, TIGARD, OR 97223-8242
(503) 521-7166
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
03/11/2016
Last updated
03/11/2016
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