Healthcare Provider Details

I. General information

NPI: 1144213133
Provider Name (Legal Business Name): DAVID EDWARD DOYLE JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 SE SUNNYSIDE RD SUITE 320
CLACKAMAS OR
97015-5745
US

IV. Provider business mailing address

10121 SE SUNNYSIDE RD SUITE 320
CLACKAMAS OR
97015-5745
US

V. Phone/Fax

Practice location:
  • Phone: 503-786-5080
  • Fax: 503-786-3483
Mailing address:
  • Phone: 503-786-5080
  • Fax: 503-786-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD6490
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: