Individual
ERIC J DIERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DMD
Contact information
Practice address
1849 NW KEARNEY ST, PORTLAND, OR 97209
(503) 224-1371
(503) 224-0722
Mailing address
1849 NW KEARNEY ST, STE 300, PORTLAND, OR 97209-1453
(503) 224-1371
(503) 224-0722
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D6708
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD16391
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008560
—
OR
Enumeration date
07/22/2005
Last updated
06/11/2018
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