Organization
SUNIL D. THANIK, DMD, MSD, LLC
Active
Other names
Progressive Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY GARCIA ROCHA (SR CREDENTIALING TEAM LEAD)
(972) 869-3789
Entity
Organization
Contact information
Practice address
12025 SW 70TH AVE, TIGARD, OR 97223-9634
(503) 924-6505
Mailing address
12025 SW 70TH AVE, TIGARD, OR 97223-9634
(503) 924-6505
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
04/01/2024
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