Individual
DR. STEVEN RAYMOND DIERICKX
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2031 HAWTHORNE ST, SUITE G, FOREST GROVE, OR 97116-1700
(503) 357-2171
(503) 357-2172
Mailing address
2031 HAWTHORNE ST, SUITE G, FOREST GROVE, OR 97116-1700
(503) 357-2171
(503) 357-2172
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4924
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4924
LICENSE NUMBER
OR
Enumeration date
04/12/2006
Last updated
07/08/2007
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