Provider Demographics
NPI:1821449547
Name:CARRION, ALEJANDRO RICARDO (DMD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:RICARDO
Last Name:CARRION
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:PO BOX 1381
Mailing Address - Street 2:15361 SE BLUFF ROAD
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-1381
Mailing Address - Country:US
Mailing Address - Phone:503-310-0489
Mailing Address - Fax:
Practice Address - Street 1:2730 SW MOODY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5042
Practice Address - Country:US
Practice Address - Phone:503-494-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist