NPI 1710317482

Willettedental

Organisation Preferred Provider Organization Beaverton, OR

Practice location

Address: 4925 SW Griffith Dr, Beaverton, OR 97005-2923
Phone: (916) 899-9665
Mailing address: PO Box 2000, Beaverton, OR 97075-2000

Authorised official

Name: Peggy Clifton
Title: Dental Hygienist
Phone: (916) 899-9665

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence H5544 (OR)

Other Preferred Provider Organization providers in Oregon →

Registry record

NPI: 1710317482
Entity type: Organization
NPI issued: 17 Nov 2013
Record last updated: 17 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.