Healthcare Provider Details

I. General information

NPI: 1578472171
Provider Name (Legal Business Name): ALBANY ODENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 29TH AVE SW
ALBANY OR
97321-3416
US

IV. Provider business mailing address

29186 SANTIAM TERRACE RD
LEBANON OR
97355-9001
US

V. Phone/Fax

Practice location:
  • Phone: 541-570-5818
  • Fax:
Mailing address:
  • Phone:
  • 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: WYATT OSBORNE
Title or Position: DENTIST
Credential: DMD
Phone: 541-570-5818