Provider Demographics
NPI:1619657913
Name:AHRAR, JASMINE ELAINE (DMD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ELAINE
Last Name:AHRAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 NW RALEIGH ST APT 262
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2295
Mailing Address - Country:US
Mailing Address - Phone:503-339-5663
Mailing Address - Fax:
Practice Address - Street 1:8070 SW HALL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6419
Practice Address - Country:US
Practice Address - Phone:503-644-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD118061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice