Healthcare Provider Details

I. General information

NPI: 1730151382
Provider Name (Legal Business Name): REBECCA KUPERSTEIN D.D.S, M.P.H., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 SE 39TH AVE
PORTLAND OR
97214-3214
US

IV. Provider business mailing address

7314 SE STEPHENS ST
PORTLAND OR
97215-3557
US

V. Phone/Fax

Practice location:
  • Phone: 503-236-3800
  • Fax: 503-236-8540
Mailing address:
  • Phone: 503-892-6287
  • Fax:

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:
Title or Position:
Credential:
Phone: