Provider Demographics
NPI:1891052122
Name:PEFECT SMILES DENTAL, LLC
Entity Type:Organization
Organization Name:PEFECT SMILES DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FAGD
Authorized Official - Phone:503-649-1700
Mailing Address - Street 1:17435 SW FARMINGTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3234
Mailing Address - Country:US
Mailing Address - Phone:503-649-1700
Mailing Address - Fax:503-649-1712
Practice Address - Street 1:17435 SW FARMINGTON RD STE D
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-3234
Practice Address - Country:US
Practice Address - Phone:503-649-1700
Practice Address - Fax:503-649-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7480305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization