Provider Demographics
NPI:1902067077
Name:DORAN, CARMEL DUDLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARMEL
Middle Name:DUDLEY
Last Name:DORAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARMEL
Other - Middle Name:ZAWIDEH
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2267 NW PETTYGROVE ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-539-1193
Mailing Address - Fax:
Practice Address - Street 1:2267 NW PETTYGROVE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-224-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-21
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220661223G0001X
ORD97081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice