| 82nd Drive Dental Clinic | |
|
15480 Se 82nd Dr Clackamas OR 97015-9633 | |
| (503) 655-7250 | |
| (503) 650-6375 |
| Full Name | 82nd Drive Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 15480 Se 82nd Dr, Clackamas, Oregon |
| Authorized Official Name and Position | Bradley W Carpenter (OWNER/ DENTIST) |
| Authorized Official Contact | 5036557250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 82nd Drive Dental Clinic Po Box 446 Clackamas OR 97015-0446 Ph: (503) 655-7250 | 82nd Drive Dental Clinic 15480 Se 82nd Dr Clackamas OR 97015-9633 Ph: (503) 655-7250 |
| NPI Number | 1740683465 |
|---|---|
| Provider Enumeration Date | 10/08/2014 |
| Last Update Date | 10/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740683465 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D8618 (Oregon) | Primary |
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