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General NPI Number Information
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NPI Number | 1124449129
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Entity Type | Organization
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Legal Business Name | VISEH SUNDBERG DDS PC
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 222 NW 10TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-3109
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Country | US
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Telephone | 503-546-9079
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Fax | 503-546-5474
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Provider Business Mailing Address
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Address Line | 222 NW 10TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-3109
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Country | US
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Telephone | 503-546-9079
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Fax | 503-546-5474
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VISEH MOVAREKHI-SUNDBERG
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Credential | DDS
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Telephone | 503-546-9079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7735
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License Number State | OR
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