Provider Demographics
NPI:1508088758
Name:REBECCA KUPERSTEIN, DDS, MPH, MS, PC
Entity Type:Organization
Organization Name:REBECCA KUPERSTEIN, DDS, MPH, MS, PC
Other - Org Name:PARKSIDE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH, MS
Authorized Official - Phone:503-236-3800
Mailing Address - Street 1:539 SE 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-236-3800
Mailing Address - Fax:503-236-8540
Practice Address - Street 1:539 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-236-3800
Practice Address - Fax:503-236-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty