MOUNTAINSIDE FAMILY DENTISTRY LLC

PORTLAND, OR
NPI1295080836
Entity TypeOrganization
Authorized ContactDEREK W. CONKLIN
Dentist/Owner/ President
503-762-2525
Organization Subpart ?No
Primary Taxonomy122300000X Dentist
(Licence: OR  D8325)
Enumeration Date2012-07-19
Last Update Date2012-07-19
Business Address
MOUNTAINSIDE FAMILY DENTISTRY LLC
3740 SE 122ND AVE
PORTLAND, OR 97236-3405
Phone number: 503-762-2525
Mailing Address
MOUNTAINSIDE FAMILY DENTISTRY LLC
3740 SE 122ND AVE
PORTLAND, OR 97236-3405
Phone number: 503-762-2525