Lifesmile Dental Group

NPI #1144416959 in Portland, Oregon

Provider Information

NPI Number: 1144416959
Entity Type: Organization
Organization Name: Lifesmile Dental Group
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 15, 2007
Last Updated: Sep 15, 2007

Practice Location

Address: 13305 NW CORNELL RD
Address 2: SUITE A
City: Portland
State: Oregon
ZIP Code: 97229-5817
Phone: (503) 644-5433

Authorized Official

Name: DR. THOMAS HICKS, DMD
Title: PRESIDENT
Phone: (503) 644-5433

Specialties & Taxonomy Codes

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

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