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General NPI Number Information
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NPI Number | 1912165093
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Entity Type | Organization
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Legal Business Name | ALDER DENTAL GROUP
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 7110 SW HAZELFERN RD SUITE 240
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City | TIGARD
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State | OR
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Zip | 97224-7776
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Country | US
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Telephone | 503-431-3200
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Fax | 503-431-3210
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Provider Business Mailing Address
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Address Line | 7110 SW HAZELFERN RD SUITE 240
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City | TIGARD
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State | OR
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Zip | 97224-7776
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Country | US
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Telephone | 503-431-3200
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Fax | 503-431-3210
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KELLY MILLER
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Credential |
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Telephone | 503-431-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D6468
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License Number State | OR
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