Provider Demographics
NPI:1912165093
Name:ALDER DENTAL GROUP
Entity Type:Organization
Organization Name:ALDER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-431-3200
Mailing Address - Street 1:7110 SW HAZELFERN RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7776
Mailing Address - Country:US
Mailing Address - Phone:503-431-3200
Mailing Address - Fax:503-431-3210
Practice Address - Street 1:7110 SW HAZELFERN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7776
Practice Address - Country:US
Practice Address - Phone:503-431-3200
Practice Address - Fax:503-431-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty