Healthcare Provider Details

I. General information

NPI: 1508945668
Provider Name (Legal Business Name): FREDERICK J MASSAR DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY #115
BEAVERTON OR
97005-3035
US

IV. Provider business mailing address

10700 SW BEAVERTON HILLSDALE HWY #115
BEAVERTON OR
97005-3035
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-2614
  • Fax: 503-643-9345
Mailing address:
  • Phone: 503-643-2614
  • Fax: 503-643-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5075
License Number StateOR

VIII. Authorized Official

Name: DR. FREDERICK JOHN MASSAR
Title or Position: PRESIDENT OF PC
Credential: DMD
Phone: 503-643-2614