Provider Demographics
NPI:1386862928
Name:MIHAILESCU, ANDREI M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREI
Middle Name:M
Last Name:MIHAILESCU
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 1:11656 SW AUKLET LOOP
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6539
Mailing Address - Country:US
Mailing Address - Phone:503-546-4645
Mailing Address - Fax:
Practice Address - Street 1:14455 SW ALLEN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4428
Practice Address - Country:US
Practice Address - Phone:503-646-2273
Practice Address - Fax:503-277-1535
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice