Healthcare Provider Details

I. General information

NPI: 1013909688
Provider Name (Legal Business Name): MARK DANIEL ALDER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SW GRIFFITH DR
BEAVERTON OR
97005-2932
US

IV. Provider business mailing address

5050 SW GRIFFITH DR
BEAVERTON OR
97005-2932
US

V. Phone/Fax

Practice location:
  • Phone: 503-641-9010
  • Fax: 503-641-7660
Mailing address:
  • Phone: 503-641-9010
  • Fax: 503-641-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5658
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: