Basic Information
| Provider Information | |||||||||
| NPI: | 1881082097 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ZOOMCARE DENTAL, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19075 NW TANASBOURNE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036848252 | ||||||||
| FaxNumber: | 8668598195 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 SE DIVISION STREET | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036848252 | ||||||||
| FaxNumber: | 8668598195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHIPLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5036848252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D10037 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.