NPI 1255761524

Willamette Dental

Organisation Preferred Provider Organization Beaverton, OR

Practice location

Address: 4925 SW Griffith Dr., Beaverton, OR 97005
Phone: (503) 352-4896
Mailing address: 16199 SW Tuscany St, Tigard, OR 97223

Authorised official

Name: Stacy Reed
Title: Dental Hygienist
Phone: (503) 352-4896

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence H5039 (OR)

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Registry record

NPI: 1255761524
Entity type: Organization
NPI issued: 22 Nov 2013
Record last updated: 22 Nov 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.