Individual
DR. BRUCE LEVOYLE RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD01/28/1950
Contact information
Practice address
3048 SW COMUS ST, PORTLAND, OR 97219-7692
(503) 484-8130
Mailing address
3048 SW COMUS ST, PORTLAND, OR 97219-7692
(503) 484-8130
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9956
OR
Other
Enumeration date
09/30/2013
Last updated
09/30/2013
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