Provider Demographics
NPI:1134609340
Name:MURESAN, BENIAMIN
Entity type:Individual
Prefix:
First Name:BENIAMIN
Middle Name:
Last Name:MURESAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 NE PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-3793
Mailing Address - Country:US
Mailing Address - Phone:503-975-7258
Mailing Address - Fax:
Practice Address - Street 1:13831 NW CORNELL RD STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5465
Practice Address - Country:US
Practice Address - Phone:503-718-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5945124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH5945OtherDENTAL HYGIENE LICENSE