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PEDIATRIC DENTAL CLINIC NPI 1679897292


NPI Information

NPI: 1679897292
Provider Name: PEDIATRIC DENTAL CLINIC
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
19255 SW 65TH AVE
SUITE 250
TUALATIN, OR
ZIP 97062
Phone: (503) 612-1897
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PEDIATRIC DENTAL CLINIC is a pediatric dentistry dentist in Tualatin, OR. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PEDIATRIC DENTAL CLINIC NPI is 1679897292. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

19255 SW 65TH AVE
SUITE 250
TUALATIN, OR
ZIP 97062-451
Phone: (503) 612-1897
Fax: (503) 612-1899

The provider's authorized official is Ben Bum-joon Kang .
The authorized official title is Owner and has the following contact phone number (503) 612-1897.

The enumeration date for this NPI number is 3/25/2010 and was last updated on 3/25/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0221XDentistPediatric DentistryYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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