| Gresham Pediatric Dentistry | |
|
831 Nw Council Dr Ste 210 Gresham OR 97030-3724 | |
| (503) 666-9436 | |
| Not Available |
| Full Name | Gresham Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 831 Nw Council Dr Ste 210, Gresham, Oregon |
| Authorized Official Name and Position | Jiyoung Lee (OWNER) |
| Authorized Official Contact | 5036669436 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gresham Pediatric Dentistry 831 Nw Council Dr Ste 210 Gresham OR 97030-3721 Ph: (503) 761-2243 | Gresham Pediatric Dentistry 831 Nw Council Dr Ste 210 Gresham OR 97030-3724 Ph: (503) 666-9436 |
| NPI Number | 1942573118 |
|---|---|
| Provider Enumeration Date | 02/17/2012 |
| Last Update Date | 06/23/2020 |
| Certification Date | 06/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942573118 | NPI | - | NPPES |
| 028475 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D8776 (Oregon) | Primary |
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