Russell Modern Dentistry, PC

NPI #1063173466 in Portland, Oregon

Provider Information

NPI Number: 1063173466
Entity Type: Organization
Organization Name: Russell Modern Dentistry, PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 7, 2022
Last Updated: Jan 7, 2022

Practice Location

Address: 1710 NE 122ND AVE
City: Portland
State: Oregon
ZIP Code: 97230-1939
Phone: (503) 295-2120

Authorized Official

Name: SUMEET S. PANDHOH, DDS
Title: OWNER
Phone: (503) 295-2120

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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