Provider Demographics
NPI:1013264308
Name:DOSE, NICHOLAS G (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:G
Last Name:DOSE
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 1:601 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2370
Mailing Address - Country:US
Mailing Address - Phone:503-636-2525
Mailing Address - Fax:503-697-5999
Practice Address - Street 1:601 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2370
Practice Address - Country:US
Practice Address - Phone:503-636-2525
Practice Address - Fax:503-697-5999
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice