| Beaverton Dental Group Pc | |
|
12755 Sw 2nd St Beaverton OR 97005-2767 | |
| (503) 644-1126 | |
| Not Available |
| Full Name | Beaverton Dental Group Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12755 Sw 2nd St, Beaverton, Oregon |
| Authorized Official Name and Position | John J Lee (OWNER) |
| Authorized Official Contact | 5036441126 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beaverton Dental Group Pc 12755 Sw 2nd St Beaverton OR 97005-2767 Ph: (503) 644-1126 | Beaverton Dental Group Pc 12755 Sw 2nd St Beaverton OR 97005-2767 Ph: (503) 644-1126 |
| NPI Number | 1093110975 |
|---|---|
| Provider Enumeration Date | 11/04/2014 |
| Last Update Date | 11/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093110975 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D7463 (Oregon) | Primary |
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