Healthcare Provider Details

I. General information

NPI: 1205519881
Provider Name (Legal Business Name): MAPLE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 CEDARWOOD CT SE
ALBANY OR
97322-6994
US

IV. Provider business mailing address

2875 CEDARWOOD CT SE
ALBANY OR
97322-6994
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-6305
  • Fax:
Mailing address:
  • Phone: 541-224-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN JAMES
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 541-666-6091