Healthcare Provider Details

I. General information

NPI: 1316269111
Provider Name (Legal Business Name): CINDY O'LOUGHLIN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2010
Last Update Date: 02/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 NW RAVEN PL
CORVALLIS OR
97330-2715
US

IV. Provider business mailing address

3410 NW RAVEN PL
CORVALLIS OR
97330-2715
US

V. Phone/Fax

Practice location:
  • Phone: 949-498-5761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8926
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number032374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: