Basic Information
| Provider Information | |||||||||
| NPI: | 1043442627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGOYO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 NE CAMPUS WAY | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032551901 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13255 SE STARK ST. | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972331809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032551901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 05/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D9264 | OR | Y | Dental Providers | Dentist | General Practice |
No ID Information.