Healthcare Provider Details

I. General information

NPI: 1538366232
Provider Name (Legal Business Name): RICHARD P. SALE, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 NW 3RD AVE
CANBY OR
97013-3602
US

IV. Provider business mailing address

333 NW 3RD AVE
CANBY OR
97013-3602
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-2705
  • Fax: 503-266-2973
Mailing address:
  • Phone: 503-266-2705
  • Fax: 503-266-2973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD4362
License Number StateOR

VIII. Authorized Official

Name: DR. RICHARD P SALE
Title or Position: PRESIDENT
Credential: DMD, PC
Phone: 503-266-2705