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General NPI Number Information
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NPI Number | 1578773933
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Entity Type | Organization
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Legal Business Name | J. NORMAN MATSCHEK, DMD, P-
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5440 SW WESTGATE DR STE 390
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City | PORTLAND
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State | OR
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Zip | 97221-2449
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Country | US
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Telephone | 503-291-7815
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Fax | 503-292-8134
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Provider Business Mailing Address
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Address Line | 5440 SW WESTGATE DR STE 390
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City | PORTLAND
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State | OR
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Zip | 97221-2449
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Country | US
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Telephone | 503-291-7815
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Fax | 503-292-8134
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Authorized Official
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Title or Position | DENTIST - PRESIDENT
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Name | DR. JOHN NORMAN MATSCHEK
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Credential | D.M.D.
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Telephone | 503-291-7815
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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 | 4748
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License Number State | OR
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