MEDICARE: DR. STEPHEN PAUL HARBOUR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6674	OR

General Provider Information

NPI Number	:	1023263522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PAUL HARBOUR DMD

Provider Business Mailing Address
First Line	:	8900 SW HALL BLVD.
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223
Country	:	US
Telephone Number	:	503-644-2000
Fax Number	:	503-644-2000

Provider Business Practice Location Address
First Line	:	8900 SW HALL BLVD.
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223
Country	:	US
Telephone Number	:	503-644-2000
Fax Number	:	503-644-2000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	11/25/2008

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