Provider Demographics
NPI:1457076432
Name:MULTNOMAH ENDODONTICS & MICROSURGERY
Entity Type:Organization
Organization Name:MULTNOMAH ENDODONTICS & MICROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUJATULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:925-642-0917
Mailing Address - Street 1:2350 SW MULTNOMAH BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3999
Mailing Address - Country:US
Mailing Address - Phone:503-841-5294
Mailing Address - Fax:
Practice Address - Street 1:2350 SW MULTNOMAH BLVD STE E
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3999
Practice Address - Country:US
Practice Address - Phone:503-841-5294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty