Provider Demographics
NPI:1780944231
Name:ADROIT DENTAL
Entity type:Organization
Organization Name:ADROIT DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRILL
Authorized Official - Middle Name:ANATIL
Authorized Official - Last Name:SMIRNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-710-9839
Mailing Address - Street 1:5493 AMY ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3320
Mailing Address - Country:US
Mailing Address - Phone:503-710-9839
Mailing Address - Fax:503-710-9839
Practice Address - Street 1:5493 AMY ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3320
Practice Address - Country:US
Practice Address - Phone:503-710-9839
Practice Address - Fax:503-710-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56607261QD0000X
WADE60102390261QD0000X
ORD8965261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental