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General NPI Number Information
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NPI Number | 1942988548
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Entity Type | Individual
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Provider Name | REEYA SHRESTHA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 12266 SW SCHOLLS FERRY RD
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City | TIGARD
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State | OR
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Zip | 97223-3354
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Country | US
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Telephone | 503-455-8483
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Fax |
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Provider Business Mailing Address
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Address Line | 134 NW NATIVE RUN LOOP
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City | GRANTS PASS
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State | OR
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Zip | 97526-1705
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | RR61427963
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11985
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License Number State | OR
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