MEDICARE: APEX DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D8049	OR

General Provider Information

NPI Number	:	1467798785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX DENTAL

Provider Business Mailing Address
First Line	:	1307 NE 102ND AVE
Second Line	:	SUITE F
City	:	PORTLAND
State	:	OR
Zip	:	97220-3980
Country	:	US
Telephone Number	:	503-256-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 NE 102ND AVE
Second Line	:	SUITE F
City	:	PORTLAND
State	:	OR
Zip	:	97220-3980
Country	:	US
Telephone Number	:	503-256-9224
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADAM HO
Credential	:	D.D.S.
Telephone Number	:	503-256-9224

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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Directions to “APEX DENTAL ” Practice Location

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