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NPI Code Detail

MEDICARE: DR. REVA M BAREWAL D.D.S.,M.S.

MEDICARE: DR. REVA M BAREWAL D.D.S.,M.S.
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
11223P0700XProsthodonticsD8178OR

General Provider Information

NPI Number : 1689888786
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REVA M BAREWAL D.D.S.,M.S.
Provider Business Mailing Address
First Line : 9300 SE 91ST AVE STE 403
Second Line :
City : HAPPY VALLEY
State : OR
Zip : 97086-3762
Country : US
Telephone Number : 503-653-2299
Fax Number : 503-774-4154
Provider Business Practice Location Address
First Line : 9300 SE 91ST AVE STE 403
Second Line :
City : HAPPY VALLEY
State : OR
Zip : 97086-3762
Country : US
Telephone Number : 503-653-2299
Fax Number : 503-774-4154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 11/14/2012

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