Provider Demographics
NPI:1548440068
Name:KASHKOULI, MELIKA (DMD)
Entity type:Individual
Prefix:DR
First Name:MELIKA
Middle Name:
Last Name:KASHKOULI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 SW 187TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3106
Mailing Address - Country:US
Mailing Address - Phone:503-649-3101
Mailing Address - Fax:
Practice Address - Street 1:3415 SW 187TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-3106
Practice Address - Country:US
Practice Address - Phone:503-649-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice