Provider Demographics
NPI:1043377443
Name:D. ANTHONY SERVICE D.M.D., P.C.
Entity type:Organization
Organization Name:D. ANTHONY SERVICE D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SERVICE
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DMD,PC
Authorized Official - Phone:503-230-7991
Mailing Address - Street 1:5050 NE HOYT ST
Mailing Address - Street 2:SUITE 528
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2991
Mailing Address - Country:US
Mailing Address - Phone:503-230-7991
Mailing Address - Fax:503-235-5487
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 528
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-230-7991
Practice Address - Fax:503-235-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR39031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1223G0001XOtherGENERAL DENTISTRY