Healthcare Provider Details

I. General information

NPI: 1396272811
Provider Name (Legal Business Name): DAVID ELDREDGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW CENTURY DR
CORVALLIS OR
97330-3498
US

IV. Provider business mailing address

2500 NW CENTURY DR
CORVALLIS OR
97330-3498
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-0600
  • Fax: 541-758-4282
Mailing address:
  • Phone: 541-750-0600
  • Fax: 541-758-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10373569
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: