Provider Demographics
NPI:1730435876
Name:PORTLAND DENTAL WORKS, LLC
Entity type:Organization
Organization Name:PORTLAND DENTAL WORKS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAZYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AFSHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-644-3188
Mailing Address - Street 1:700 NE MULTNOMAH ST
Mailing Address - Street 2:SUITE 845
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2131
Mailing Address - Country:US
Mailing Address - Phone:503-234-0000
Mailing Address - Fax:503-235-3369
Practice Address - Street 1:700 NE MULTNOMAH ST
Practice Address - Street 2:SUITE 845
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2131
Practice Address - Country:US
Practice Address - Phone:503-234-0000
Practice Address - Fax:503-235-3369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTLAND DENTAL WORKS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR94781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty