Provider Demographics
NPI:1003183849
Name:SOUTHEAST DENTAL PROFESSIONALS
Entity Type:Organization
Organization Name:SOUTHEAST DENTAL PROFESSIONALS
Other - Org Name:SOLUTIONS FOR SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SINHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-255-6815
Mailing Address - Street 1:1238 SE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233
Mailing Address - Country:US
Mailing Address - Phone:503-255-6815
Mailing Address - Fax:503-255-3044
Practice Address - Street 1:1238 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-255-6815
Practice Address - Fax:503-255-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty