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General NPI Number Information
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NPI Number | 1003467358
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Entity Type | Organization
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Legal Business Name | JADE DENTAL LLC
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 12450 SW PIONEER LN
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City | BEAVERTON
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State | OR
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Zip | 97008-8377
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Country | US
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Telephone | 510-501-4317
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Fax |
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Provider Business Mailing Address
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Address Line | 3570 SW RIVER PKWY UNIT 1611
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City | PORTLAND
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State | OR
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Zip | 97239-4544
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Country | US
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Telephone | 510-501-4317
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK CHING HSIANG CHUANG
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Credential | DDS
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Telephone | 510-501-4317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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