Provider Demographics
NPI:1710735048
Name:SERENITY DENTAL, LLC
Entity type:Organization
Organization Name:SERENITY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-974-0500
Mailing Address - Street 1:29292 SW TOWN CENTER LOOP E STE B
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9491
Mailing Address - Country:US
Mailing Address - Phone:503-974-0500
Mailing Address - Fax:503-974-0505
Practice Address - Street 1:29292 SW TOWN CENTER LOOP E STE B
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9491
Practice Address - Country:US
Practice Address - Phone:503-974-0500
Practice Address - Fax:503-974-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty