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Provider Information for 1952329526



DR. IRINA MOGA DDS

Gender: FEMALE

Individual NPI: 1952329526

Calendar Last Updated: 2016-11-16

Details

Name Value
NPI 1952329526
Enumeration Date 2006-07-18
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 14425 SW ALLEN BLVD SUITE 200
BEAVERTON, OR 97005-4402
United States

Phone: 503-646-5909 | Fax: 503-646-5909
View Map External Link
Primary Practice Address 4970 SW MAIN AVE SUITE 200
BEAVERTON, OR 97005-2740
United States

Phone: 503-646-5909 | Fax: 503-646-5908
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice OR D8510
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location