| NPI | 1598223919 |
|---|---|
| Doing Business As | PORTLAND MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | AUSTIN TODD Owner Dentist 714-845-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2022-03-09 |