Provider Demographics
NPI:1336264357
Name:SAMUEL, RAJI MATHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:RAJI
Middle Name:MATHEW
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19553 SW BOULDER LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8903
Mailing Address - Country:US
Mailing Address - Phone:503-860-0809
Mailing Address - Fax:
Practice Address - Street 1:510 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3910
Practice Address - Country:US
Practice Address - Phone:503-472-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist