Individual
JASON ATACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
14125 SW FARMINGTON RD, BEAVERTON, OR 97005-2567
(503) 646-4432
(971) 223-1710
Mailing address
14125 SW FARMINGTON RD, BEAVERTON, OR 97005-2567
(503) 646-4432
(971) 223-1710
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9201
OR
1223G0001X
General Practice Dentistry
9201
OR
Other
Enumeration date
10/30/2008
Last updated
01/31/2018
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