MEDICARE: STEVEN R ELKJER 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	6586	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6586	OTHER	OR	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1538154737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN R ELKJER DMD

Provider Business Mailing Address
First Line	:	5861 SW BEAVERTON HILLSDALE HWY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-1925
Country	:	US
Telephone Number	:	503-292-5483
Fax Number	:	503-292-5483

Provider Business Practice Location Address
First Line	:	5861 SW BEAVERTON HILLSDALE HWY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-1925
Country	:	US
Telephone Number	:	503-292-5483
Fax Number	:	503-292-5483

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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Directions to “ STEVEN R ELKJER DMD” Practice Location

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