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General NPI Number Information
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NPI Number | 1063596690
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Entity Type | Organization
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Legal Business Name | OREGON HEALTH AND SCIENCE UNIVERSITY
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 2730 S MOODY AVE
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City | PORTLAND
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State | OR
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Zip | 97201-5042
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Country | US
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Telephone | 503-494-8867
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Fax | 503-494-2365
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Provider Business Mailing Address
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Address Line | 2730 S MOODY AVE
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City | PORTLAND
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State | OR
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Zip | 97201-5042
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Country | US
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Telephone | 503-494-8867
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Fax | 503-494-2365
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Authorized Official
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Title or Position | DEAN
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Name | PHILLIP T MARUCHA
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Credential | DMD, PHD
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Telephone | 503-494-8801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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