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NPI Code Detail

MEDICARE: CRIS DENTAL GROUP

MEDICARE: CRIS DENTAL GROUP
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1679849053
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRIS DENTAL GROUP
Provider Business Mailing Address
First Line : 3019 NW STEWART PKWY
Second Line : STE 304, #305
City : ROSEBURG
State : OR
Zip : 97471-1602
Country : US
Telephone Number : 541-672-2747
Fax Number : 541-672-2754
Provider Business Practice Location Address
First Line : 5892 MAIN ST STE 4
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97478-5496
Country : US
Telephone Number : 541-672-2747
Fax Number : 541-672-2757
Authorized Official
Title or Position : OWNER
Name : DR. MICHAEL J BRATLAND
Credential : DMD
Telephone Number : 541-672-2747
Provider Enumeration Date : 03/29/2012
Last Update Date : 03/29/2012

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Directions to “CRIS DENTAL GROUP ” Practice Location

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