MEDICARE: CASCADE DENTAL GROUP, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1659839124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADE DENTAL GROUP, LLC

Provider Business Mailing Address
First Line	:	1296 COMMERCIAL ST SE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4200
Country	:	US
Telephone Number	:	503-399-0724
Fax Number	:	503-371-7344

Provider Business Practice Location Address
First Line	:	1296 COMMERCIAL ST SE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4200
Country	:	US
Telephone Number	:	503-399-0724
Fax Number	:	503-371-7344

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CATHERINE M DAHL
Credential	:	DMD
Telephone Number	:	503-399-0724

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	11/03/2022

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Directions to “CASCADE DENTAL GROUP, LLC ” Practice Location

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