MEDICARE: GARRETT MASUDA DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D12113	OR

General Provider Information

NPI Number	:	1801517255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT MASUDA DDS, MS

Provider Business Mailing Address
First Line	:	4419 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6271
Country	:	US
Telephone Number	:	909-680-0846
Fax Number	:

Provider Business Practice Location Address
First Line	:	4419 SE WOODSTOCK BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-6271
Country	:	US
Telephone Number	:	503-379-0562
Fax Number	:

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

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	01/22/2025

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