Provider Demographics
NPI:1659430841
Name:WASSERMAN, JOEL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 SW 142ND PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5553
Mailing Address - Country:US
Mailing Address - Phone:503-643-3442
Mailing Address - Fax:503-626-7885
Practice Address - Street 1:511 SW 10TH AVE
Practice Address - Street 2:SUITE 1206
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2732
Practice Address - Country:US
Practice Address - Phone:503-227-1693
Practice Address - Fax:503-227-2362
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist