Provider Demographics
NPI:1366847881
Name:PROGRESS DENTAL LLC
Entity Type:Organization
Organization Name:PROGRESS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-726-8295
Mailing Address - Street 1:17680 SW HANDLEY ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9255
Mailing Address - Country:US
Mailing Address - Phone:503-925-9595
Mailing Address - Fax:503-925-9626
Practice Address - Street 1:17680 SW HANDLEY ST
Practice Address - Street 2:STE 101
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9255
Practice Address - Country:US
Practice Address - Phone:503-925-9595
Practice Address - Fax:503-925-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty