Provider Demographics
NPI:1295954717
Name:WILEY, DAVID B (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:WILEY
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 1:2330 NW FLANDERS ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3460
Mailing Address - Country:US
Mailing Address - Phone:503-223-5040
Mailing Address - Fax:503-222-3101
Practice Address - Street 1:2330 NW FLANDERS ST STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3460
Practice Address - Country:US
Practice Address - Phone:503-223-5040
Practice Address - Fax:503-222-3101
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD68281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice