Provider Demographics
NPI:1689888786
Name:BAREWAL, REVA M (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:REVA
Middle Name:M
Last Name:BAREWAL
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 SE 91ST AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3762
Mailing Address - Country:US
Mailing Address - Phone:503-653-2299
Mailing Address - Fax:503-774-4154
Practice Address - Street 1:9300 SE 91ST AVE STE 403
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3762
Practice Address - Country:US
Practice Address - Phone:503-653-2299
Practice Address - Fax:503-774-4154
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD81781223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics