Healthcare Provider Details

I. General information

NPI: 1851609416
Provider Name (Legal Business Name): ERIC M CADWELL DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 NE BEND RIVER MALL AVE
BEND OR
97703-7528
US

IV. Provider business mailing address

80 NE BEND RIVER MALL AVE
BEND OR
97703-7528
US

V. Phone/Fax

Practice location:
  • Phone: 541-647-5555
  • Fax: 541-647-5554
Mailing address:
  • Phone: 541-647-5555
  • Fax: 541-617-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD9502
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC CADWELL
Title or Position: OWNER
Credential: D.D.S.
Phone: 541-639-5200