Healthcare Provider Details

I. General information

NPI: 1598763427
Provider Name (Legal Business Name): GERALD JOSEPH PAPADOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 NE DIVISION ST
GRESHAM OR
97030-6020
US

IV. Provider business mailing address

2484 NE DIVISION ST
GRESHAM OR
97030-6020
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-2442
  • Fax: 503-669-8876
Mailing address:
  • Phone: 503-667-2442
  • Fax: 503-669-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberOR5008
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: