Bridgeport Family Dental, LLC

NPI #1740553106 in Tigard, Oregon

Provider Information

NPI Number: 1740553106
Entity Type: Organization
Organization Name: Bridgeport Family Dental, LLC
Primary Specialty: Dentist
Enumeration Date: Feb 15, 2012
Last Updated: Feb 15, 2012

Practice Location

Address: 7420 SW BRIDGEPORT RD STE 104
City: Tigard
State: Oregon
ZIP Code: 97224-7790
Phone: (503) 430-7909

Authorized Official

Name: DR. KELLY JEAN JOHNSON, D.D.S.
Title: OWNER/DENTIST
Phone: (503) 430-7909

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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