Healthcare Provider Details

I. General information

NPI: 1194983171
Provider Name (Legal Business Name): MICHAEL W. GEHLEN D.M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 SW TUALATIN RD
TUALATIN OR
97062-9425
US

IV. Provider business mailing address

7940 SW 191ST AVE
BEAVERTON OR
97007-9017
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-1450
  • Fax: 503-352-9395
Mailing address:
  • Phone: 503-692-1450
  • Fax: 503-352-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD4430
License Number StateOR

VIII. Authorized Official

Name: DR. MICHAEL WILLIAM GEHLEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 503-692-1450