Healthcare Provider Details

I. General information

NPI: 1487725719
Provider Name (Legal Business Name): ROY PETER GUERIN III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 GAME FARM RD
SPRINGFIELD OR
97477-7513
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: 503-526-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD7113
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: