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General NPI Number Information
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NPI Number | 1659806776
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Entity Type | Organization
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Legal Business Name | THEODORE R. RASK, DMD, P.C.
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 16055 SW REGATTA LN 800
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City | BEAVERTON
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State | OR
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Zip | 97006-8303
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Country | US
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Telephone | 503-880-1299
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Fax |
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Provider Business Mailing Address
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Address Line | 16055 SW REGATTA LN 800
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City | BEAVERTON
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State | OR
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Zip | 97006-8303
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Country | US
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Telephone | 503-880-1299
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE R RASK
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Credential | DMD
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Telephone | 503-880-1299
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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 | D9772
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License Number State | OR
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