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1902476682
JACOB GROOM
PORTLAND, OR
NPI
1902476682
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: OR D11457)
Enumeration Date
2021-06-25
Last Update Date
2021-06-25
Business Address
JACOB GROOM DMD
13908 SE STARK ST STE B
PORTLAND, OR 97233-2161
Phone number: 503-253-4979
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Mailing Address
JACOB GROOM DMD
13908 SE STARK ST STE B
PORTLAND, OR 97233-2161
Phone number: 503-253-4979
Copy
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