Provider Demographics
NPI:1487545166
Name:SPECTRA DENTAL CARE LLC
Entity type:Organization
Organization Name:SPECTRA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJI
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-688-4639
Mailing Address - Street 1:19553 SW BOULDER LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8903
Mailing Address - Country:US
Mailing Address - Phone:503-688-4639
Mailing Address - Fax:
Practice Address - Street 1:19553 SW BOULDER LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8903
Practice Address - Country:US
Practice Address - Phone:503-688-4639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental