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General NPI Number Information
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NPI Number | 1588816557
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Entity Type | Organization
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Legal Business Name | DENTISTRY BY DESIGN, PC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 11380 SW BEAVERTON HILLSDALE HWY
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City | BEAVERTON
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State | OR
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Zip | 97005-3018
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Country | US
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Telephone | 503-626-7323
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1420
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City | BEAVERTON
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State | OR
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Zip | 97075-1420
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Country | US
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Telephone | 503-626-7323
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOZE GHOMGHALEH
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Credential |
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Telephone | 503-626-7323
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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 | D7365
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D7585
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License Number State | OR
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