Provider Demographics
NPI:1396884052
Name:ROY F DORNSIFE
Entity type:Organization
Organization Name:ROY F DORNSIFE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DRONSIFE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-643-8848
Mailing Address - Street 1:8625 SW CASCADE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-643-8848
Mailing Address - Fax:503-350-1974
Practice Address - Street 1:8625 SW CASCADE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:503-643-8848
Practice Address - Fax:503-350-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD71241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty