Healthcare Provider Details

I. General information

NPI: 1508088758
Provider Name (Legal Business Name): REBECCA KUPERSTEIN, DDS, MPH, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 SE 39TH AVE
PORTLAND OR
97214
US

IV. Provider business mailing address

539 SE 39TH AVE
PORTLAND OR
97214
US

V. Phone/Fax

Practice location:
  • Phone: 503-236-3800
  • Fax: 503-236-8540
Mailing address:
  • Phone: 503-236-3800
  • Fax: 503-236-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD8632
License Number StateOR

VIII. Authorized Official

Name: DR. REBECCA KUPERSTEIN
Title or Position: PRESIDENT
Credential: DDS, MPH, MS
Phone: 503-236-3800