Provider Demographics
NPI:1356382055
Name:EUBANKS, JOSHUA (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:EUBANKS
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 1:14320 SW ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4403
Mailing Address - Country:US
Mailing Address - Phone:503-526-1330
Mailing Address - Fax:503-626-7635
Practice Address - Street 1:14320 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4403
Practice Address - Country:US
Practice Address - Phone:503-526-1330
Practice Address - Fax:503-626-7635
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice