Provider Demographics
NPI:1215014519
Name:PHILIP J. GROSS D.D.S., P.C.
Entity Type:Organization
Organization Name:PHILIP J. GROSS D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILI;
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:503-223-5125
Mailing Address - Street 1:101 SW MAIN ST STE 290
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3244
Mailing Address - Country:US
Mailing Address - Phone:503-223-5125
Mailing Address - Fax:503-221-6915
Practice Address - Street 1:101 SW MAIN ST STE 290
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3244
Practice Address - Country:US
Practice Address - Phone:503-223-5125
Practice Address - Fax:503-221-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD54641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty