Provider Demographics
NPI:1073872404
Name:WAYNE H MORI
Entity type:Organization
Organization Name:WAYNE H MORI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:HARUO
Authorized Official - Last Name:MORI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-230-8814
Mailing Address - Street 1:700 NE MULTHOMAH
Mailing Address - Street 2:SUITE 850
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-230-8814
Mailing Address - Fax:503-233-2264
Practice Address - Street 1:700 NE MULTHOMAH
Practice Address - Street 2:SUITE 850
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-230-8814
Practice Address - Fax:503-233-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty