Individual
MICHAEL MOGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
12400 SW ALLEN BLVD, SUITE B, BEAVERTON, OR 97005-4714
(503) 643-6213
Mailing address
12400 SW ALLEN BLVD, SUITE B, BEAVERTON, OR 97005-4714
(503) 643-6213
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-188851
OR
Other
Enumeration date
01/31/2007
Last updated
07/08/2007
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