Provider Demographics
NPI:1831647593
Name:DAVID N CAROTHERS DDS PC
Entity Type:Organization
Organization Name:DAVID N CAROTHERS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:CAROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-257-3033
Mailing Address - Street 1:10101 SE MAIN ST
Mailing Address - Street 2:SUITE 3009
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2455
Mailing Address - Country:US
Mailing Address - Phone:503-257-3033
Mailing Address - Fax:503-253-8723
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:SUITE 3009
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2455
Practice Address - Country:US
Practice Address - Phone:503-257-3033
Practice Address - Fax:503-253-8723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty