Healthcare Provider Details

I. General information

NPI: 1750675468
Provider Name (Legal Business Name): KEVIN S. DORIUS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 SW PHILOMATH BLVD
CORVALLIS OR
97333-1042
US

IV. Provider business mailing address

5208 SW PHILOMATH BLVD
CORVALLIS OR
97333-1042
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-8000
  • Fax: 541-766-4776
Mailing address:
  • Phone: 435-668-1642
  • Fax: 541-766-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9836
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: