Provider Demographics
NPI:1033488838
Name:EAST WIND DENTAL CARE
Entity Type:Organization
Organization Name:EAST WIND DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YURIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANABE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-614-0198
Mailing Address - Street 1:PO BOX 3083
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3083
Mailing Address - Country:US
Mailing Address - Phone:503-614-0198
Mailing Address - Fax:
Practice Address - Street 1:7546 NE SHALEEN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9430
Practice Address - Country:US
Practice Address - Phone:503-614-0198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty