JACOB GROOM

PORTLAND, OR
NPI1902476682
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: OR  D11457)
Enumeration Date2021-06-25
Last Update Date2021-06-25
Business Address
JACOB GROOM DMD
13908 SE STARK ST STE B
PORTLAND, OR 97233-2161
Phone number: 503-253-4979
Mailing Address
JACOB GROOM DMD
13908 SE STARK ST STE B
PORTLAND, OR 97233-2161
Phone number: 503-253-4979
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