Provider Demographics
NPI:1518046564
Name:LAURELWOOD DENTAL LLC
Entity Type:Organization
Organization Name:LAURELWOOD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:POZDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-284-3575
Mailing Address - Street 1:2824 NE WASCO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1772
Mailing Address - Country:US
Mailing Address - Phone:503-284-3575
Mailing Address - Fax:503-284-4139
Practice Address - Street 1:2824 NE WASCO ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1772
Practice Address - Country:US
Practice Address - Phone:503-284-3575
Practice Address - Fax:503-284-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR56871223G0001X
OR76741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty