| Organization Name: | BEAVERTON DENTAL CENTER LLC |
| NPI Number: | 1023367513 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN WILLIAMS (OWNER) |
| Mailing Address: | 11673 Sw Beaverton Hillsdale Hwy Beaverton |
| State: | OR US |
| Postal Code: | 970052928 |
| Phone Number: | 5036414328 |
| Fax Number: | 5036448454 |
| NPI Enumeration Date: | 08/30/2012 |
| NPI Last Update Date: | 08/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | 27130 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |