Provider Demographics
NPI:1831110592
Name:MICHAEL YAREMKO DMDPC
Entity Type:Organization
Organization Name:MICHAEL YAREMKO DMDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-761-4001
Mailing Address - Street 1:2517 SE 179TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1035
Mailing Address - Country:US
Mailing Address - Phone:503-761-4001
Mailing Address - Fax:503-761-0559
Practice Address - Street 1:2517 SE 179TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1035
Practice Address - Country:US
Practice Address - Phone:503-761-4001
Practice Address - Fax:503-761-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR50161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty