Healthcare Provider Details

I. General information

NPI: 1710031802
Provider Name (Legal Business Name): SPRING CREEK FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 SE HARRISON ST
MILWAUKIE OR
97222-7587
US

IV. Provider business mailing address

2636 SE HARRISON ST
MILWAUKIE OR
97222-7587
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-9658
  • Fax: 503-513-9597
Mailing address:
  • Phone: 503-659-9658
  • Fax: 503-513-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6711
License Number StateOR

VIII. Authorized Official

Name: KAREN WELIKY
Title or Position: DENTIST
Credential: DMD
Phone: 503-659-9658