Organization
STONEBROOK FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LYLE MCCULLOUGH D.M.D (OWNER)
(503) 964-8909
Entity
Organization
Contact information
Practice address
2236 PACIFIC AVE, FOREST GROVE, OR 97116-2448
(503) 359-5481
Mailing address
7647 SW 189TH AVE, BEAVERTON, OR 97007-7607
(503) 964-8909
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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