Healthcare Provider Details

I. General information

NPI: 1023729969
Provider Name (Legal Business Name): BREATHE DEEP DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61583 SE 27TH ST SUITE TBD
BEND OR
97702
US

IV. Provider business mailing address

548 NW HARMON BLVD
BEND OR
97703-3022
US

V. Phone/Fax

Practice location:
  • Phone: 541-262-6101
  • Fax:
Mailing address:
  • Phone: 541-419-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SOPHIE ROSE MORRELL DIEPENHEIM
Title or Position: OWNER/MEMBER
Credential: DMD
Phone: 541-262-6101