Provider Demographics
NPI:1336126531
Name:POPESCU, OCTAVIAN R (DDS)
Entity Type:Individual
Prefix:
First Name:OCTAVIAN
Middle Name:R
Last Name:POPESCU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68479
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97268-0479
Mailing Address - Country:US
Mailing Address - Phone:503-786-5949
Mailing Address - Fax:
Practice Address - Street 1:17497 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:OR
Practice Address - Zip Code:97267-5906
Practice Address - Country:US
Practice Address - Phone:503-786-5949
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD75011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice