Provider Demographics
NPI:1083963243
Name:SAM EL-EBRASHI, BDS, MS, PC
Entity Type:Organization
Organization Name:SAM EL-EBRASHI, BDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:K
Authorized Official - Last Name:EL-EBRASHI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS
Authorized Official - Phone:503-226-6659
Mailing Address - Street 1:2075 SW FIRST AVE
Mailing Address - Street 2:STE. 2M
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5314
Mailing Address - Country:US
Mailing Address - Phone:503-226-6659
Mailing Address - Fax:503-226-9523
Practice Address - Street 1:2075 SW FIRST AVE
Practice Address - Street 2:STE. 2M
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5314
Practice Address - Country:US
Practice Address - Phone:503-226-6659
Practice Address - Fax:503-226-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD47641223G0001X
ORD86501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty