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General NPI Number Information
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NPI Number | 1699009605
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Entity Type | Organization
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Legal Business Name | GEHRED FAMILY DENTAL
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 4839 NE 42ND AVE
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City | PORTLAND
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State | OR
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Zip | 97218
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Country | US
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Telephone | 503-284-6469
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Fax | 503-288-0490
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Provider Business Mailing Address
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Address Line | 4839 NE 42ND AVE
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City | PORTLAND
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State | OR
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Zip | 97218
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Country | US
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Telephone | 503-284-6469
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Fax | 503-288-0490
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. NEIL GEHRED
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Credential | D.D.S.
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Telephone | 503-284-6469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D9242
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License Number State | OR
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