Provider Demographics
NPI:1811121932
Name:BEAVERTON ORAL SURGEONS
Entity type:Organization
Organization Name:BEAVERTON ORAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-646-7101
Mailing Address - Street 1:3925 SW 153RD DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4168
Mailing Address - Country:US
Mailing Address - Phone:503-646-7101
Mailing Address - Fax:503-646-7105
Practice Address - Street 1:3925 SW 153RD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4166
Practice Address - Country:US
Practice Address - Phone:503-646-7101
Practice Address - Fax:503-646-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery