Provider Demographics
NPI:1699009605
Name:GEHRED FAMILY DENTAL
Entity Type:Organization
Organization Name:GEHRED FAMILY DENTAL
Other - Org Name:WILSHIRE DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEHRED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-284-6469
Mailing Address - Street 1:4839 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218
Mailing Address - Country:US
Mailing Address - Phone:503-284-6469
Mailing Address - Fax:503-288-0490
Practice Address - Street 1:4839 NE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218
Practice Address - Country:US
Practice Address - Phone:503-284-6469
Practice Address - Fax:503-288-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty