Individual
MOUSTAPHA SY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16755 SW BASELINE RD STE 106, BEAVERTON, OR 97006-4284
(503) 352-5450
(503) 746-5448
Mailing address
16755 SW BASELINE RD STE 106, BEAVERTON, OR 97006-4284
(503) 352-5450
(503) 746-5448
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11230
OR
122300000X
Dentist
D11230
OR
1223G0001X
General Practice Dentistry
Primary
D11230
OR
Other
Enumeration date
06/05/2020
Last updated
07/08/2022
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