Healthcare Provider Details

I. General information

NPI: 1518250471
Provider Name (Legal Business Name): AFFORDABLE DENTURES WILSONVILLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8229 SW WILSONVILLE RD
WILSONVILLE OR
97070
US

IV. Provider business mailing address

8229 SW WILSONVILLE RD
WILSONVILLE OR
97070
US

V. Phone/Fax

Practice location:
  • Phone: 503-685-9303
  • Fax:
Mailing address:
  • Phone: 503-685-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE PEARSON
Title or Position: OWNER
Credential: DDS
Phone: 503-685-9303