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General NPI Number Information
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NPI Number | 1871368142
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Entity Type | Individual
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Provider Name | BRANDON JAN ZEGAROWSKI DDS
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Gender | Male
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 5216 SE WOODSTOCK BLVD
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City | PORTLAND
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State | OR
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Zip | 97206-6150
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Country | US
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Telephone | 925-286-6422
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 S RIVER PKWY UNIT 2500
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City | PORTLAND
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State | OR
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Zip | 97239-4565
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Country | US
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Telephone | 925-286-6422
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11914
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License Number State | OR
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