Individual
DR. ROBERT W. SOUTHWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D. M. D.
Contact information
Practice address
1822 NE 33RD AVE, PORTLAND, OR 97212-5112
(503) 249-0770
(503) 280-1118
Mailing address
1822 NE 33RD AVE, PORTLAND, OR 97212-5112
(503) 249-0770
(503) 280-1118
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5220
OR
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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