1194983171 NPI number — MICHAEL W. GEHLEN D.M.D.,P.C.

Table of content: (NPI 1194983171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194983171 NPI number — MICHAEL W. GEHLEN D.M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL W. GEHLEN D.M.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1194983171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7940 SW 191ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97007-9017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-692-1450
Provider Business Mailing Address Fax Number:
503-352-9395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8555 SW TUALATIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUALATIN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97062-9425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-692-1450
Provider Business Practice Location Address Fax Number:
503-352-9395
Provider Enumeration Date:
05/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GEHLEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-692-1450

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D4430 , 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)

  • Identifier: D4430 . This is a "STATE LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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