Healthcare Provider Details

I. General information

NPI: 1932529914
Provider Name (Legal Business Name): DR. PAWANDEEP SEKHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 SW 1ST ST
BEAVERTON OR
97005-0550
US

IV. Provider business mailing address

430 SW 13TH AVE APT 1002
PORTLAND OR
97205-2361
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-5230
  • Fax:
Mailing address:
  • Phone: 503-890-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD9987
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: