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Dental Providers Dentist

Provider NPI: 1568870681

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 541-882-9039  Fax: 541-850-8840

Business Mailing Address:
Tel: 541-892-6628  Fax: 541-850-8840

NPI Information:
NPI: 1568870681
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 122300000X





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