Individual
RARES N DECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
18395 SW ALEXANDER ST, ALOHA, OR 97003-3961
(503) 642-4552
Mailing address
18395 SW ALEXANDER ST, ALOHA, OR 97003-3961
(503) 642-4552
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
055991
NY
1223E0200X
Endodontics
Primary
D10376
OR
1223E0200X
Endodontics
DE60705325
WA
1223G0001X
General Practice Dentistry
DL10639
MA
Other
Enumeration date
07/07/2009
Last updated
10/18/2023
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