Provider Demographics
NPI:1285015768
Name:SHAYEGAN, ASHKAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:
Last Name:SHAYEGAN
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 1:5861 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1925
Mailing Address - Country:US
Mailing Address - Phone:503-292-5483
Mailing Address - Fax:503-297-5015
Practice Address - Street 1:5861 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1925
Practice Address - Country:US
Practice Address - Phone:503-292-5483
Practice Address - Fax:503-297-5015
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD106341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice