Provider Demographics
NPI:1508945668
Name:FREDERICK J MASSAR DMD PC
Entity Type:Organization
Organization Name:FREDERICK J MASSAR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-643-2614
Mailing Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:#115
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3035
Mailing Address - Country:US
Mailing Address - Phone:503-643-2614
Mailing Address - Fax:503-643-9345
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:#115
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3035
Practice Address - Country:US
Practice Address - Phone:503-643-2614
Practice Address - Fax:503-643-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty