Portland Modern Dentistry, PC

NPI #1598223919 in Portland, Oregon

Provider Information

NPI Number: 1598223919
Entity Type: Organization
Organization Name: Portland Modern Dentistry, PC
Primary Specialty: Dentist
Enumeration Date: Mar 5, 2019
Last Updated: Mar 9, 2022

Practice Location

Address: 5175 NE MARTIN LUTHER KING BLVD STE 110
City: Portland
State: Oregon
ZIP Code: 97211-3233
Phone: (503) 406-1108

Authorized Official

Name: DR. AUSTIN TODD, DDS
Title: OWNER DENTIST
Phone: (714) 845-8500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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