Dierks, Eric J

Dierks, Eric J is an individual health care provider with primary practice located at 1849 Nw Kearney St , Portland OR 97209. He recently has only one registered license in Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, which is considered as his primary health care specialty. Dierks, Eric J can be contacted via phone (503) 224-1371.

Contact Information

Primary practice address
1849 Nw Kearney St Portland OR 97209
Phone: (503) 224-1371
Fax: (503) 224-0722
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X D6708 Oregon
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X MD16391 Oregon

Profile Details

NPI number 1265432025
LBN Legal business name Dierks, Eric J
Credentials MD, DMD
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2005
Last updated Jun 11th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265432025 NPPES
Oregon MEDICAID 008560

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