Provider Demographics
NPI:1508311424
Name:MITRA GASPEED
Entity Type:Organization
Organization Name:MITRA GASPEED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:MITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-322-9504
Mailing Address - Street 1:8615 SW THOROUGHBRED PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7200
Mailing Address - Country:US
Mailing Address - Phone:971-322-9504
Mailing Address - Fax:
Practice Address - Street 1:8615 SW THOROUGHBRED PL.
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:971-322-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4642124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty