| Forest Grove Kids' Dentist, Llc | |
|
2742 19th Ave Forest Grove OR 97116-2623 | |
| (360) 852-0809 | |
| Not Available |
| Full Name | Forest Grove Kids' Dentist, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2742 19th Ave, Forest Grove, Oregon |
| Authorized Official Name and Position | Timothy Richardson (OWNER) |
| Authorized Official Contact | 3608520809 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forest Grove Kids' Dentist, Llc 2742 19th Ave Forest Grove OR 97116-2623 Ph: () - | Forest Grove Kids' Dentist, Llc 2742 19th Ave Forest Grove OR 97116-2623 Ph: (360) 852-0809 |
| NPI Number | 1932524956 |
|---|---|
| Provider Enumeration Date | 02/27/2014 |
| Last Update Date | 02/27/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932524956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D9577 (Oregon) | Primary |
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