Healthcare Provider Details

I. General information

NPI: 1972666956
Provider Name (Legal Business Name): DAVID A. GOLDWYN, DDS, PC
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

2350 SW MULTNOMAH BLVD
PORTLAND OR
97219-3999
US

IV. Provider business mailing address

2350 SW MULTNOMAH BLVD
PORTLAND OR
97219-3999
US

V. Phone/Fax

Practice location:
  • Phone: 503-245-0180
  • Fax: 503-452-3634
Mailing address:
  • Phone: 503-245-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD8010
License Number StateOR

VIII. Authorized Official

Name: DAVID A GOLDWYN
Title or Position: PERIODONTIST
Credential: D.D.S.
Phone: 503-245-0180