Provider Demographics
NPI:1831253335
Name:VANDUSEN, MARK JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:VANDUSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:503-952-2164
Mailing Address - Fax:503-526-4418
Practice Address - Street 1:4925 SW GRIFFITH DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2923
Practice Address - Country:US
Practice Address - Phone:503-277-2014
Practice Address - Fax:503-277-2263
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORD69361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics