Healthcare Provider Details

I. General information

NPI: 1073426359
Provider Name (Legal Business Name): NICOLE S TASOOJI DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 SW CHANDLER AVE STE 201
BEND OR
97702-3240
US

IV. Provider business mailing address

1475 SW CHANDLER AVE STE 201
BEND OR
97702-3240
US

V. Phone/Fax

Practice location:
  • Phone: 458-214-8691
  • Fax:
Mailing address:
  • Phone: 458-214-8691
  • 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. NICOLE SARAH TASOOJI
Title or Position: DOCTOR/OWNER
Credential: DMD
Phone: 858-349-7111