MEDICARE: TIMBER DENTAL - LOMBARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1356073910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMBER DENTAL - LOMBARD

Provider Business Mailing Address
First Line	:	1440 N LOMBARD ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N LOMBARD ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5533
Country	:	US
Telephone Number	:	503-809-8210
Fax Number	:

Authorized Official
Title or Position	:	RCM LEAD
Name	:	HEATHER RIGGS
Credential	:
Telephone Number	:	541-543-0083

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	12/28/2022

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Directions to “TIMBER DENTAL - LOMBARD ” Practice Location

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