Healthcare Provider Details

I. General information

NPI: 1578689659
Provider Name (Legal Business Name): PAYNTER FAMILY DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W POWELL BLVD
GRESHAM OR
97030-7048
US

IV. Provider business mailing address

445 W POWELL BLVD
GRESHAM OR
97030-7048
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-7000
  • Fax: 503-669-2080
Mailing address:
  • Phone: 503-666-7000
  • Fax: 503-669-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8720
License Number StateOR

VIII. Authorized Official

Name: DR. MITCHELL M PAYNTER
Title or Position: PRESIDENT
Credential: DMD
Phone: 503-666-7000