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General NPI Number Information
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NPI Number | 1962579094
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Entity Type | Individual
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Provider Name | MO BIRIA DMD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 19157 WILLAMETTE DR
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City | WEST LINN
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State | OR
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Zip | 97068-2019
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Country | US
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Telephone | 503-635-4493
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Fax |
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Provider Business Mailing Address
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Address Line | 19485 SUNCREST DR
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City | WEST LINN
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State | OR
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Zip | 97068-1955
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Country | US
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Telephone | 503-635-4493
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D8412
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License Number State | OR
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