MEDICARE: SLEEP DENTISTRY OF PORTLAND

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	4528	OR

General Provider Information

NPI Number	:	1811995632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DENTISTRY OF PORTLAND

Provider Business Mailing Address
First Line	:	19265 SE STARK ST
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97233-5758
Country	:	US
Telephone Number	:	503-666-9519
Fax Number	:	503-666-1147

Provider Business Practice Location Address
First Line	:	19265 SE STARK ST
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97233-5758
Country	:	US
Telephone Number	:	503-666-9519
Fax Number	:	503-666-1147

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. FLOYD HOWARD KASCH
Credential	:	DMD
Telephone Number	:	503-666-9519

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	06/26/2008

Similar Medicare Providers

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Directions to “SLEEP DENTISTRY OF PORTLAND ” Practice Location

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