Provider Demographics
NPI:1437154465
Name:MCCOMB, JOHN ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:MCCOMB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2119
Mailing Address - Country:US
Mailing Address - Phone:503-223-5223
Mailing Address - Fax:
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:STE 500
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2119
Practice Address - Country:US
Practice Address - Phone:503-223-5223
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
OR52981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice