Provider Demographics
NPI:1871106849
Name:SHAIKH HUSSEIN, HUSEIN (DMD)
Entity type:Individual
Prefix:
First Name:HUSEIN
Middle Name:
Last Name:SHAIKH HUSSEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23473
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3473
Mailing Address - Country:US
Mailing Address - Phone:503-709-0090
Mailing Address - Fax:
Practice Address - Street 1:1275 OREGON AVE SE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9102
Practice Address - Country:US
Practice Address - Phone:541-837-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist