1174796619 NPI number — DR. DAIN CAMERON PAXTON I DMD

Table of content: DR. DAIN CAMERON PAXTON I DMD (NPI 1174796619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174796619 NPI number — DR. DAIN CAMERON PAXTON I DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAXTON
Provider First Name:
DAIN
Provider Middle Name:
CAMERON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174796619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 SW 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 1006
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97204-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-228-1470
Provider Business Mailing Address Fax Number:
503-228-4907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 SW 5TH AVE STE 1006
Provider Second Line Business Practice Location Address:
SUITE 1006
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97204-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-228-1470
Provider Business Practice Location Address Fax Number:
503-228-4907
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  53394 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 7397 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)