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Dental Providers Dentist Pediatric Dentistry

Provider NPI: 1467451716

Provider Information:
Gender: M

Practice Location:
Tel: 503-656-0631  Fax: 503-557-8113

Business Mailing Address:
Tel: 503-656-0631  Fax: 503-557-8113

NPI Information:
NPI: 1467451716
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Pediatric Dentistry

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 1223P0221X





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