Dtaley, Charles Richard
Dtaley, Charles Richard is an sole proprietor health care provider with primary practice located at 14495 Sw Allen Blvd , Beaverton OR 97005-4427. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Dtaley, Charles Richard can be contacted via phone (503) 526-0318.Contact Information
Primary practice address
14495 Sw Allen Blvd
Beaverton OR 97005-4427
Phone: (503) 526-0318
Fax: (503) 626-1054
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | 4879 | Oregon |
Profile Details
| NPI number | 1750451555 |
|---|---|
| LBN Legal business name | Dtaley, Charles Richard |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 9th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750451555 | NPPES |
| Oregon | Other | 6783 | OREGON HEALTH PLAN |
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