Healthcare Provider Details

I. General information

NPI: 1851940407
Provider Name (Legal Business Name): THOMAS GRASS, DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15925 SE STARK ST
PORTLAND OR
97233-3525
US

IV. Provider business mailing address

15925 SE STARK ST
PORTLAND OR
97233-3525
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-1096
  • Fax: 503-253-0291
Mailing address:
  • Phone: 503-253-1096
  • Fax: 503-253-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS JAMES GRASS
Title or Position: OWNER
Credential: DMD
Phone: 503-702-3080