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General NPI Number Information
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NPI Number | 1629935218
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Entity Type | Organization
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Legal Business Name | MODERN EDGE DENTAL, LLC
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 18676 WILLAMETTE DR STE 202
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City | WEST LINN
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State | OR
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Zip | 97068-1718
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Country | US
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Telephone | 503-708-7201
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Fax |
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Provider Business Mailing Address
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Address Line | 19804 SW JETTE LN
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City | BEAVERTON
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State | OR
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Zip | 97003-2791
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MILTON EDUARDO RAMIREZ CUEVAS
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Credential | DMD
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Telephone | 503-708-7201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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