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General NPI Number Information
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NPI Number | 1962845453
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Entity Type | Organization
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Legal Business Name | GEELAN DENTAL CARE LLC
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 101 SW MAIN ST SUITE 290
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City | PORTLAND
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State | OR
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Zip | 97204-3228
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Country | US
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Telephone | 503-223-1322
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Fax | 503-221-6915
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Provider Business Mailing Address
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Address Line | 101 SW MAIN ST SUITE 290
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City | PORTLAND
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State | OR
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Zip | 97204-3228
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Country | US
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Telephone | 503-223-1322
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Fax | 503-221-6915
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Authorized Official
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Title or Position | DENTIST
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Name | ARON GEELAN
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Credential | DMD
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Telephone | 503-223-1322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H1576
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H4563
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D9499
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License Number State | OR
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