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General NPI Number Information
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NPI Number | 1750656377
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Entity Type | Organization
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Legal Business Name | IRINA MOGA DDS PC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 14475 SW ALLEN BLVD
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City | BEAVERTON
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State | OR
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Zip | 97005-4418
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Country | US
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Telephone | 503-646-5909
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Fax | 503-646-5908
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Provider Business Mailing Address
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Address Line | 14425 SW ALLEN BLVD
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City | BEAVERTON
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State | OR
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Zip | 97005-4402
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Country | US
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Telephone | 503-646-5909
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Fax | 503-646-5908
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRINA MOGA
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Credential | DDS
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Telephone | 503-646-5909
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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 | D8510
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License Number State | OR
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