Provider Demographics
NPI:1932529914
Name:SEKHON, PAWANDEEP
Entity Type:Individual
Prefix:DR
First Name:PAWANDEEP
Middle Name:
Last Name:SEKHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SW 13TH AVE
Mailing Address - Street 2:APT 1002
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2361
Mailing Address - Country:US
Mailing Address - Phone:503-890-6245
Mailing Address - Fax:
Practice Address - Street 1:12520 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0550
Practice Address - Country:US
Practice Address - Phone:503-646-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD99871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice