MEDICARE: CARING SMILES DENTAL, LLC

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	D9387	OR

General Provider Information

NPI Number	:	1528562535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARING SMILES DENTAL, LLC

Provider Business Mailing Address
First Line	:	15000 SW BARROWS RD STE 204
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-8778
Country	:	US
Telephone Number	:	503-430-5096
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 SW BARROWS RD STE 204
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-8778
Country	:	US
Telephone Number	:	503-430-5096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN ALLRED
Credential	:	DMD
Telephone Number	:	503-348-4442

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	03/23/2018

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