Organization
OREGON HEALTH & SCIENCE UNIVERSITY
Active
Other names
DIAGNOSTIC LAB OHSU DENTISTRY SCH
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY STEWART DDS (PRESIDENT)
(503) 494-8904
Entity
Organization
Contact information
Practice address
2730 SW MOODY AVE, SD-PATH, PORTLAND, OR 97201-5042
(503) 494-8904
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182769
—
CA
Enumeration date
03/30/2006
Last updated
08/04/2014
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