MR. Matthew Edward Bourg, DMD

NPI #1902994312 in Portland, Oregon

Provider Information

NPI Number: 1902994312
Entity Type: Individual
Name: MR. Matthew Edward Bourg, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DMD
Enumeration Date: Oct 11, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 17236 SE STARK ST
City: Portland
State: Oregon
ZIP Code: 97233-4546
Phone: (503) 254-1260

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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