Provider Demographics
NPI:1447979265
Name:BELHOUCHAT, DRISS LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:DRISS
Middle Name:LEE
Last Name:BELHOUCHAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 W PAMELA RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-4036
Mailing Address - Country:US
Mailing Address - Phone:916-765-6003
Mailing Address - Fax:
Practice Address - Street 1:8660 SW SCHOLLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6621
Practice Address - Country:US
Practice Address - Phone:503-616-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist