Healthcare Provider Details

I. General information

NPI: 1467516211
Provider Name (Legal Business Name): CHIRGWIN & HERRIGES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 SE 122ND AVE
PORTLAND OR
97233-1112
US

IV. Provider business mailing address

1130 SE 122ND AVE
PORTLAND OR
97233-1112
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-5515
  • Fax: 503-255-1625
Mailing address:
  • Phone: 503-252-5515
  • Fax: 503-255-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD8371
License Number StateOR

VIII. Authorized Official

Name: DR. BROCK D HERRIGES
Title or Position: PARTNER
Credential: DMD
Phone: 503-252-5515