MEDICARE: OCTAVIAN R. POPESCU D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D7501	OR

General Provider Information

NPI Number	:	1336126531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OCTAVIAN R. POPESCU D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 68479
Second Line	:
City	:	OAK GROVE
State	:	OR
Zip	:	97268-0479
Country	:	US
Telephone Number	:	503-786-5949
Fax Number	:

Provider Business Practice Location Address
First Line	:	17497 SE MCLOUGHLIN BLVD
Second Line	:
City	:	OAK GROVE
State	:	OR
Zip	:	97267-5906
Country	:	US
Telephone Number	:	503-786-5949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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