MEDICARE: DR. JONATHAN VINCENT ROXAS DDS

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	D7827	OR

General Provider Information

NPI Number	:	1710982830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN VINCENT ROXAS DDS

Provider Business Mailing Address
First Line	:	6227 SE POWELL BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-2749
Country	:	US
Telephone Number	:	503-777-1332
Fax Number	:	360-777-9990

Provider Business Practice Location Address
First Line	:	6227 SE POWELL BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-2749
Country	:	US
Telephone Number	:	503-777-1332
Fax Number	:	360-777-9990

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	10/03/2011

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