Mountainside Family Dentistry LLC

NPI #1295080836 in Portland, Oregon

Provider Information

NPI Number: 1295080836
Entity Type: Organization
Organization Name: Mountainside Family Dentistry LLC
Primary Specialty: Dentist
Enumeration Date: Jul 19, 2012
Last Updated: Jul 19, 2012

Practice Location

Address: 3740 SE 122ND AVE
City: Portland
State: Oregon
ZIP Code: 97236-3405
Phone: (503) 762-2525

Authorized Official

Name: DR. DEREK W. CONKLIN, DMD
Title: DENTIST/OWNER/ PRESIDENT
Phone: (503) 762-2525

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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