Grant Park Dentistry, PC

NPI #1205220209 in Portland, Oregon

Provider Information

NPI Number: 1205220209
Entity Type: Organization
Organization Name: Grant Park Dentistry, PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 27, 2015
Last Updated: Mar 27, 2015

Practice Location

Address: 3280 NE BROADWAY
City: Portland
State: Oregon
ZIP Code: 97232
Phone: (503) 282-0521

Authorized Official

Name: DR. TODD R COCKRELL, DDS
Title: OWNER
Phone: (503) 282-0521

Specialties & Taxonomy Codes

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

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