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General NPI Number Information
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NPI Number | 1689888786
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Entity Type | Individual
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Provider Name | REVA M BAREWAL D.D.S.,M.S.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 9300 SE 91ST AVE STE 403
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-3762
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Country | US
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Telephone | 503-653-2299
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Fax | 503-774-4154
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Provider Business Mailing Address
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Address Line | 9300 SE 91ST AVE STE 403
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-3762
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Country | US
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Telephone | 503-653-2299
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Fax | 503-774-4154
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D8178
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License Number State | OR
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