Individual
KEITH L VALACHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9900 SW WILSHIRE ST., SUITE 120, PORTLAND, OR 97225
(971) 271-7478
(503) 296-2967
Mailing address
9900 SW WILSHIRE ST., SUITE 120, PORTLAND, OR 97225
(971) 271-7478
(503) 296-2967
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6487
OR
332BC3200X
Customized Equipment (DME)
D6487
OR
Other
Enumeration date
04/12/2006
Last updated
08/27/2019
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