Provider Demographics
NPI:1801396593
Name:MIDLAND DENTAL LLC
Entity Type:Organization
Organization Name:MIDLAND DENTAL LLC
Other - Org Name:MIDLAND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUREDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-252-8338
Mailing Address - Street 1:1244 SE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1202
Mailing Address - Country:US
Mailing Address - Phone:503-252-8338
Mailing Address - Fax:
Practice Address - Street 1:1244 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1202
Practice Address - Country:US
Practice Address - Phone:503-252-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty