Provider Demographics
NPI:1578746368
Name:CENTER FOR DERMATOLOGY AND LASER SURGERY P C
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGY AND LASER SURGERY P C
Other - Org Name:CENTER FOR DERMATOLOGY AND LASER SURGERY, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RYDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-297-3440
Mailing Address - Street 1:5920 NE RAY CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6313
Mailing Address - Country:US
Mailing Address - Phone:503-297-3440
Mailing Address - Fax:
Practice Address - Street 1:5920 NE RAY CIR STE 200
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6313
Practice Address - Country:US
Practice Address - Phone:503-297-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty