MEDICARE: J. NORMAN MATSCHEK, DMD, P-

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	261QD0000X	Dental Clinic/Center	4748	OR

General Provider Information

NPI Number	:	1578773933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. NORMAN MATSCHEK, DMD, P-

Provider Business Mailing Address
First Line	:	5440 SW WESTGATE DR STE 390
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-2449
Country	:	US
Telephone Number	:	503-291-7815
Fax Number	:	503-292-8134

Provider Business Practice Location Address
First Line	:	5440 SW WESTGATE DR STE 390
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-2449
Country	:	US
Telephone Number	:	503-291-7815
Fax Number	:	503-292-8134

Authorized Official
Title or Position	:	DENTIST - PRESIDENT
Name	:	DR. JOHN NORMAN MATSCHEK
Credential	:	D.M.D.
Telephone Number	:	503-291-7815

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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