Healthcare Provider Details

I. General information

NPI: 1477470052
Provider Name (Legal Business Name): EASTSIDE BEND SMILES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 NE MEDICAL CENTER DR STE 220
BEND OR
97701-7359
US

IV. Provider business mailing address

1239 NE MEDICAL CENTER DR STE 220
BEND OR
97701-7359
US

V. Phone/Fax

Practice location:
  • Phone: 541-200-7798
  • Fax: 541-330-1430
Mailing address:
  • Phone: 541-200-7798
  • Fax: 541-330-1430

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: THOMAS SPOONSTER
Title or Position: OWNER, DOCTOR
Credential: DDS
Phone: 541-200-7798