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1902994312
MATTHEW EDWARD BOURG
PORTLAND, OR
NPI
1902994312
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
122300000X Dentist
(Licence: OR D6261)
Enumeration Date
2006-10-11
Last Update Date
2007-07-08
Business Address
MR. MATTHEW EDWARD BOURG DMD
17236 SE STARK ST
PORTLAND, OR 97233-4546
Phone number: 503-254-1260
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Mailing Address
MR. MATTHEW EDWARD BOURG DMD
17236 SE STARK ST
PORTLAND, OR 97233-4546
Phone number: 503-254-1260
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