Healthcare Provider Details

I. General information

NPI: 1467375618
Provider Name (Legal Business Name): OVEYSEH SHABAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SE 3RD AVE
HILLSBORO OR
97123-4019
US

IV. Provider business mailing address

13055 SW SAINT JAMES LN
TIGARD OR
97224-6114
US

V. Phone/Fax

Practice location:
  • Phone: 503-213-1257
  • Fax:
Mailing address:
  • Phone: 503-746-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12407
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: