Healthcare Provider Details

I. General information

NPI: 1952246597
Provider Name (Legal Business Name): TIMBERLINE DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E JEFFERSON AVE
COTTAGE GROVE OR
97424-2120
US

IV. Provider business mailing address

1164 SW 14TH ST
LINCOLN CITY OR
97367-2304
US

V. Phone/Fax

Practice location:
  • Phone: 971-777-0470
  • Fax:
Mailing address:
  • Phone: 971-777-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER LAHTI
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 971-777-0470