Provider Demographics
NPI:1164519708
Name:HADI NOUREDINE DMD
Entity Type:Organization
Organization Name:HADI NOUREDINE DMD
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KATI
Authorized Official - Last Name:MARECEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-644-1110
Mailing Address - Street 1:8070 SW HALL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6419
Mailing Address - Country:US
Mailing Address - Phone:503-644-1110
Mailing Address - Fax:503-641-6431
Practice Address - Street 1:8070 SW HALL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6419
Practice Address - Country:US
Practice Address - Phone:503-644-1110
Practice Address - Fax:503-641-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR010640OtherOFFICE OF MEDICAL ASS
OR278353Medicaid
OR768520OtherUNITED CONCORDIA