Stonebrook Family Dental, LLC
Clinic/Center, Dental in Forest Grove, OR. Organization (NPI-2).
NPI number1982208559
StatusActive
Last updated in NPPESNov 24, 2020
Details
- NPI
- 1982208559
- Entity type
- Organization (NPI-2)
- Legal business name
- Stonebrook Family Dental, LLC
- Organization subpart
- No
- Enumeration date
- Nov 24, 2020
- Certification date
- Nov 24, 2020
- Last updated
- Nov 24, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
2236 Pacific AveForest Grove, OR 97116-2448
Phone 503-359-5481
Mailing address
7647 Sw 189th AveBeaverton, OR 97007-7607
Phone 503-964-8909
Authorized official
Robert Lyle McCullough
Owner
5039648909
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