Beaverton Dental Group PC

NPI #1093110975 in Beaverton, Oregon

Provider Information

NPI Number: 1093110975
Entity Type: Organization
Organization Name: Beaverton Dental Group PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 4, 2014
Last Updated: Nov 4, 2014

Practice Location

Address: 12755 SW 2ND ST
City: Beaverton
State: Oregon
ZIP Code: 97005-2767
Phone: (503) 644-1126

Authorized Official

Name: JOHN J LEE, DDS
Title: OWNER
Phone: (503) 644-1126

Specialties & Taxonomy Codes

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

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