| Gresham DG LLC | |
|
455 West Powell Blvd Gresham OR 97030 | |
| (503) 661-9696 | |
| Not Available |
| Full Name | Gresham DG LLC |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 455 West Powell Blvd, Gresham, Oregon |
| Authorized Official Name and Position | Ryan Smith (MANAGER) |
| Authorized Official Contact | 9717089540 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gresham DG LLC 455 West Powell Blvd Gresham OR 97030 | Gresham DG LLC 455 West Powell Blvd Gresham OR 97030 Ph: (503) 661-9696 |
| NPI Number | 1184362329 |
|---|---|
| Provider Enumeration Date | 05/26/2022 |
| Last Update Date | 05/26/2022 |
| Certification Date | 05/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184362329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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