Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Russell Modern Dentistry, PC

Organization General Practice Dentistry · NPI 1063173466

Russell Modern Dentistry, PC is a General Practice Dentistry in Portland, Oregon. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1710 NE 122nd Ave
Portland, OR 97230-1939
Phone: (503) 295-2120
Fax: (503) 305-3342
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1063173466
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Sumeet Pandhoh — Owner · (503) 295-2120
Other names Russell Modern Dentistry
NPI enumeratedJanuary 7, 2022
Last updated in NPPESJanuary 7, 2022
Certification dateJanuary 7, 2022
Mailing addressPo Box 920050, Dallas, TX 75392-0050

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