Individual
ALISTAIR L KOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12750 SE STARK ST BLDG E, PORTLAND, OR 97233-1539
(971) 347-3009
(971) 256-3277
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10201
OR
1223G0001X
General Practice Dentistry
0401410812
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2164640
—
WA
05
—
500691396
—
OR
Enumeration date
10/27/2006
Last updated
03/26/2021
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