Provider Demographics
NPI:1790857894
Name:CANFIELD, DALE EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:EDWARD
Last Name:CANFIELD
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 1:101 SW MAIN ST
Mailing Address - Street 2:#290
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3228
Mailing Address - Country:US
Mailing Address - Phone:503-223-1322
Mailing Address - Fax:503-221-6915
Practice Address - Street 1:101 SW MAIN ST
Practice Address - Street 2:#290
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3228
Practice Address - Country:US
Practice Address - Phone:503-223-1322
Practice Address - Fax:503-221-6915
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR35321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice