Main Street Dental

NPI #1124571369 in Gresham, Oregon

Provider Information

NPI Number: 1124571369
Entity Type: Organization
Organization Name: Main Street Dental
Primary Specialty: Dentist
Enumeration Date: Jul 23, 2016
Last Updated: Jul 23, 2016

Practice Location

Address: 810 N MAIN AVE
City: Gresham
State: Oregon
ZIP Code: 97030-5538
Phone: (503) 665-8283

Authorized Official

Name: KATE HARMSTON
Title: OFFICE MANAGER
Phone: (503) 665-8283

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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