Healthcare Provider Details

I. General information

NPI: 1164595930
Provider Name (Legal Business Name): RAJIV RAMCHANDRA PAONASKAR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 SE FOSTER RD
PORTLAND OR
97266-4661
US

IV. Provider business mailing address

6950 NE CAMPUS WAY
HILLSBORO OR
97124-5611
US

V. Phone/Fax

Practice location:
  • Phone: 855-433-6825
  • Fax:
Mailing address:
  • Phone: 503-952-2164
  • Fax: 503-256-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD6851
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: