82nd Drive Dental Clinic

NPI #1740683465 in Clackamas, Oregon

Provider Information

NPI Number: 1740683465
Entity Type: Organization
Organization Name: 82nd Drive Dental Clinic
Primary Specialty: Dentist
Enumeration Date: Oct 8, 2014
Last Updated: Oct 8, 2014

Practice Location

Address: 15480 SE 82ND DR
City: Clackamas
State: Oregon
ZIP Code: 97015-9633
Phone: (503) 655-7250

Authorized Official

Name: BRADLEY W CARPENTER, DMD
Title: OWNER/ DENTIST
Phone: (503) 655-7250

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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