Healthcare Provider Details

I. General information

NPI: 1740197771
Provider Name (Legal Business Name): SYDNEY A MANSOUR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 SW DARTMOUTH ST STE 180
PORTLAND OR
97223-8292
US

IV. Provider business mailing address

10170 SW CRYSTAL ST
BEAVERTON OR
97008-6536
US

V. Phone/Fax

Practice location:
  • Phone: 503-620-2319
  • Fax:
Mailing address:
  • Phone: 541-390-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12396
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: