Provider Demographics
NPI:1619996170
Name:SCHWAB, MARY KAY (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KAY
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SW 5TH AVE
Mailing Address - Street 2:SUITE 1006
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1428
Mailing Address - Country:US
Mailing Address - Phone:503-228-1470
Mailing Address - Fax:503-229-4907
Practice Address - Street 1:620 SW 5TH AVE
Practice Address - Street 2:SUITE 1006
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1428
Practice Address - Country:US
Practice Address - Phone:503-228-1470
Practice Address - Fax:503-229-4907
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice