Basic Information
| Provider Information | |||||||||
| NPI: | 1811052277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKOURTES | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 NE CAMPUS WAY | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522164 | ||||||||
| FaxNumber: | 5035264418 | ||||||||
| Practice Location | |||||||||
| Address1: | 1933 SW JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972012405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032738240 | ||||||||
| FaxNumber: | 5032284944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 122300000X | D4363 | OR | Y | Dental Providers | Dentist | 122300000X | 7031 | WA | N | Dental Providers | Dentist | 122300000X | D3346 | ID | N | Dental Providers | Dentist |
No ID Information.