Willamette

NPI #1649692450 in Gresham, Oregon

Provider Information

NPI Number: 1649692450
Entity Type: Organization
Organization Name: Willamette
Primary Specialty: Dentist
Enumeration Date: Jan 13, 2014
Last Updated: Jan 13, 2014

Practice Location

Address: 1107 NE BURNSIDE RD
City: Gresham
State: Oregon
ZIP Code: 97030-5710
Phone: (503) 952-2167

Authorized Official

Name: DR. SHEIDA KHARRAZI, DMD
Title: DENTIST
Phone: (503) 310-0923

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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