Individual
SOROUSH AMALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7201 N INTERSTATE AVE, PORTLAND, OR 97217-5523
(503) 286-6868
Mailing address
2730 SW MOODY AVE, PORTLAND, OR 97201-5042
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10530
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2016
Last updated
11/02/2020
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