Gresham Dg LLC

NPI #1184362329 in Gresham, Oregon

Provider Information

NPI Number: 1184362329
Entity Type: Organization
Organization Name: Gresham Dg LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: May 26, 2022
Last Updated: May 26, 2022

Practice Location

Address: 455 WEST POWELL BLVD
City: Gresham
State: Oregon
ZIP Code: 97030
Phone: (503) 661-9696

Authorized Official

Name: RYAN SMITH, DDS
Title: MANAGER
Phone: (971) 708-9540

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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