Healthcare Provider Details

I. General information

NPI: 1013871433
Provider Name (Legal Business Name): DENTURE IN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 NE 4TH ST
BEND OR
97701-4709
US

IV. Provider business mailing address

853 NE 4TH ST
BEND OR
97701-4709
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-7485
  • Fax:
Mailing address:
  • Phone: 541-389-7485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: TAD BURZYNSKI
Title or Position: OWNER
Credential: L.D.
Phone: 541-389-7485