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General NPI Number Information
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NPI Number | 1235569070
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Entity Type | Organization
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Legal Business Name | JUSTUS ORTHODONTICS LLC
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 11790 SW BARNES RD STE 390
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City | PORTLAND
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State | OR
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Zip | 97225-5935
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Country | US
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Telephone | 503-352-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 11790 SW BARNES RD STE 390
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City | PORTLAND
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State | OR
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Zip | 97225-5935
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Country | US
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Telephone | 503-352-3800
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Fax | 503-352-0207
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAMARA JUSTUS
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Credential |
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Telephone | 503-352-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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