Provider Demographics
NPI:1740553312
Name:DEWAN, MEENAKSHI (DDS)
Entity type:Individual
Prefix:DR
First Name:MEENAKSHI
Middle Name:
Last Name:DEWAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEENAKSHI
Other - Middle Name:
Other - Last Name:LNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 NE ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6043
Mailing Address - Country:US
Mailing Address - Phone:503-531-8300
Mailing Address - Fax:
Practice Address - Street 1:11982 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2143
Practice Address - Country:US
Practice Address - Phone:503-257-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist