1851764138 NPI number — OREGON ENDODONTICS LLC

Table of content: (NPI 1851764138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851764138 NPI number — OREGON ENDODONTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OREGON ENDODONTICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851764138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 CATRON ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONMOUTH
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97361-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-400-4726
Provider Business Mailing Address Fax Number:
503-838-7210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 CATRON ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONMOUTH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97361-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-400-4726
Provider Business Practice Location Address Fax Number:
503-838-7210
Provider Enumeration Date:
11/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHURTZ
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
HOMER
Authorized Official Title or Position:
SOLE MEMBER/ OWNER
Authorized Official Telephone Number:
503-400-4726

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  D10144 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1841553609 . This is a "PERSONAL NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com