Permanente Dental Associates, PC
Health Maintenance Organization in Tigard, OR. Organization (NPI-2).
NPI number1669492500
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1669492500
- Entity type
- Organization (NPI-2)
- Legal business name
- Permanente Dental Associates, PC
- Organization subpart
- No
- Enumeration date
- Jul 21, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302R00000X | Health Maintenance Organization | 5960 | OR | Yes |
Practice location
7105 Sw Hampton StTigard, OR 97223-8314
Phone 503-684-9274
Mailing address
28556 Sw Cascade LoopWilsonville, OR 97070-8747
Phone 503-682-6206
Authorized official
Donald Prasnicar
Dental Director
5036849274
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