Healthcare Provider Details

I. General information

NPI: 1538097043
Provider Name (Legal Business Name): HEALTHY ROOTS ENDODONTICS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NW NEWPORT AVE
BEND OR
97703-1838
US

IV. Provider business mailing address

630 NW SILVER BUCKLE
BEND OR
97703-9086
US

V. Phone/Fax

Practice location:
  • Phone: 970-214-9412
  • Fax:
Mailing address:
  • Phone: 970-214-9412
  • Fax: 970-214-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: RYAN HEDIGER
Title or Position: OWNER/OPERATOR
Credential: DMD
Phone: 970-214-9412