Provider Demographics
NPI:1275040404
Name:ORAL AND FACIAL SURGERY
Entity Type:Organization
Organization Name:ORAL AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUPINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DHADLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:503-547-8879
Mailing Address - Street 1:6125 NE CORNELL RD STE 320
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6125 NE CORNELL RD STE 320
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5417
Practice Address - Country:US
Practice Address - Phone:503-547-8879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7931261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery