Provider Demographics
NPI:1225220122
Name:GRASVIK, NICHOLAS MADDEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MADDEN
Last Name:GRASVIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16230 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4657
Mailing Address - Country:US
Mailing Address - Phone:503-654-9565
Mailing Address - Fax:503-654-0472
Practice Address - Street 1:16230 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4657
Practice Address - Country:US
Practice Address - Phone:503-654-9565
Practice Address - Fax:503-654-0472
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist