Organization
BIOLOGIC DENTAL PC
Active
Other names
Summit Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY PETER DEWEY DDS (PRESIDENT)
(503) 265-9847
Entity
Organization
Contact information
Practice address
973 NW SALTZMAN RD, PORTLAND, OR 97229-5647
(503) 644-7202
Mailing address
3826 SE LIEBE ST, PORTLAND, OR 97202-4034
(503) 265-9847
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D8706
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851455935
—
OR
Enumeration date
02/28/2018
Last updated
06/16/2018
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