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Contact Information

BROOKSIDE DENTAL-GRESHAM
4255 SE 182ND AVE
GRESHAM, OR97030-5083
 Phone: 503-666-2515
 Fax: 503-618-9254
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
Indicates primary specialty

NPI Profile & details for BROOKSIDE DENTAL-GRESHAM

NPI # 1700201464
LBN Legal business name BROOKSIDE DENTAL-GRESHAM
Authorized official BRIAN WESTOVER - (OWNER/DENTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 03/04/2014
Last updated 03/04/2014 - About 12 years ago
Identifiers
OR License # D7444
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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