Healthcare Provider Details

I. General information

NPI: 1437991015
Provider Name (Legal Business Name): K SQUARED SMILES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 SW BARROWS RD STE 204
BEAVERTON OR
97007-8778
US

IV. Provider business mailing address

1322 NE ORENCO STATION PKWY STE 300
HILLSBORO OR
97124-5411
US

V. Phone/Fax

Practice location:
  • Phone: 503-803-1742
  • Fax:
Mailing address:
  • Phone: 503-803-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BRANDON KEARBEY
Title or Position: MEMBER / OWNER
Credential: DDS
Phone: 503-803-1742