MEDICARE: EUGENE ENDODOTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	8541	OR

General Provider Information

NPI Number	:	1427200138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE ENDODOTICS LLC

Provider Business Mailing Address
First Line	:	2233 WILLAMETTE ST.
Second Line	:	SUITE E
City	:	EUGENE
State	:	OR
Zip	:	97405-2890
Country	:	US
Telephone Number	:	541-484-9018
Fax Number	:	541-345-8037

Provider Business Practice Location Address
First Line	:	2233 WILLAMETTE ST STE E
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-2890
Country	:	US
Telephone Number	:	541-484-9018
Fax Number	:	541-345-8037

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID EARL WILSON
Credential	:	DDS
Telephone Number	:	541-484-9018

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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Directions to “EUGENE ENDODOTICS LLC ” Practice Location

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