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General NPI Number Information
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NPI Number | 1518927979
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Entity Type | Individual
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Provider Name | GORDON ROY HOVERSLAND DMD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4350 SW CEDAR HILLS BLVD
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City | BEAVERTON
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State | OR
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Zip | 97005-2013
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Country | US
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Telephone | 503-644-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 255 SW 173RD AVE
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City | BEAVERTON
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State | OR
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Zip | 97006-4112
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Country | US
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Telephone | 503-645-1002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5961
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License Number State | OR
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