Provider Demographics
NPI:1790785673
Name:SAKLOFSKY, BRIAN R (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:SAKLOFSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 SW GREENBURG RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1406
Mailing Address - Country:US
Mailing Address - Phone:503-598-0898
Mailing Address - Fax:503-620-3197
Practice Address - Street 1:10500 SW GREENBURG RD
Practice Address - Street 2:SUITE #3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-1406
Practice Address - Country:US
Practice Address - Phone:503-598-0898
Practice Address - Fax:503-620-3197
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
OR61091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice