Biologic Dental PC
Clinic/Center, Dental in Portland, OR. Organization (NPI-2).
NPI number1982106407
StatusActive
Last updated in NPPESJun 16, 2018
Details
- NPI
- 1982106407
- Entity type
- Organization (NPI-2)
- Legal business name
- Biologic Dental PC
- Organization subpart
- No
- Enumeration date
- Feb 28, 2018
- Last updated
- Jun 16, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | D8706 | OR | Yes |
Other names
- Summit Dental (Doing Business As)
Practice location
973 Nw Saltzman RdPortland, OR 97229-5647
Phone 503-644-7202
Mailing address
3826 Se Liebe StPortland, OR 97202-4034
Phone 503-265-9847
Authorized official
Jeffrey Peter Dewey
President
5032659847
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