Individual
IRA POVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
249 NW 3RD AVE, CANBY, OR 97013-3601
(971) 206-7134
(541) 535-4377
Mailing address
3617 S PACIFIC HWY, MEDFORD, OR 97501-8957
(541) 535-6239
(541) 535-4377
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8424
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022868
—
OR
01
—
94-3096772
TAX ID
—
Enumeration date
06/18/2006
Last updated
02/24/2020
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