Healthcare Provider Details

I. General information

NPI: 1386603116
Provider Name (Legal Business Name): SUNSET DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/22/2020
Certification Date:
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: 541-766-4667
Mailing address:
  • Phone: 541-766-8000
  • Fax: 541-766-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6655
License Number StateOR

VIII. Authorized Official

Name: DR. LINDA D SELBY
Title or Position: OWNER
Credential: DMD
Phone: 541-766-8000