Provider Demographics
NPI:1093009706
Name:K. DAVID CARNEIRO
Entity Type:Organization
Organization Name:K. DAVID CARNEIRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OSTERHOLME
Authorized Official - Suffix:
Authorized Official - Credentials:EFDA
Authorized Official - Phone:503-325-3533
Mailing Address - Street 1:1775 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3508
Mailing Address - Country:US
Mailing Address - Phone:503-325-3533
Mailing Address - Fax:503-325-3609
Practice Address - Street 1:1775 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3508
Practice Address - Country:US
Practice Address - Phone:503-325-3533
Practice Address - Fax:503-325-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7028261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental