Healthcare Provider Details

I. General information

NPI: 1295759421
Provider Name (Legal Business Name): ROBERT FRANCIS FEREK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 NW BURNSIDE RD KAISER PERM DENTAL
GRESHAM OR
97030-3852
US

IV. Provider business mailing address

30711 SE JACKSON RD
GRESHAM OR
97080-8932
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-7480
  • Fax: 503-667-7498
Mailing address:
  • Phone: 503-663-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6954
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: