Provider Demographics
NPI:1356305924
Name:VALACHI, KEITH L
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:L
Last Name:VALACHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:LASZLO
Other - Last Name:VALACHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9900 SW WILSHIRE ST.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:971-271-7478
Mailing Address - Fax:503-296-2967
Practice Address - Street 1:9900 SW WILSHIRE ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:971-271-7478
Practice Address - Fax:503-296-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6487332BC3200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty