Provider Demographics
NPI:1407223050
Name:NEDELCU, STEFAN (DMD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:NEDELCU
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 1:12948 SW TEAROSE WAY
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6686
Mailing Address - Country:US
Mailing Address - Phone:503-484-4491
Mailing Address - Fax:
Practice Address - Street 1:20673 SW ROY ROGERS RD STE 201
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9222
Practice Address - Country:US
Practice Address - Phone:503-484-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10342122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice