Provider Demographics
NPI:1396337762
Name:DR DENTISTS HOUSECALLS
Entity type:Organization
Organization Name:DR DENTISTS HOUSECALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-285-5307
Mailing Address - Street 1:5835 N . INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217
Mailing Address - Country:US
Mailing Address - Phone:503-285-5307
Mailing Address - Fax:503-285-3462
Practice Address - Street 1:5835 N . INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217
Practice Address - Country:US
Practice Address - Phone:503-285-5307
Practice Address - Fax:503-285-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty