Healthcare Provider Details

I. General information

NPI: 1780944231
Provider Name (Legal Business Name): ADROIT DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5493 AMY ST
WEST LINN OR
97068-3320
US

IV. Provider business mailing address

5493 AMY ST
WEST LINN OR
97068-3320
US

V. Phone/Fax

Practice location:
  • Phone: 503-710-9839
  • Fax: 503-710-9839
Mailing address:
  • Phone: 503-710-9839
  • Fax: 503-710-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number56607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE60102390
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD8965
License Number StateOR

VIII. Authorized Official

Name: DR. KIRILL ANATIL SMIRNOFF
Title or Position: SECRETARY
Credential: DMD
Phone: 503-710-9839