Healthcare Provider Details

I. General information

NPI: 1053231027
Provider Name (Legal Business Name): AMY PUGH DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 SW CLUBHOUSE RD
CROOKED RIVER RANCH OR
97760-8021
US

IV. Provider business mailing address

5021 SW CLUBHOUSE RD
CROOKED RIVER RANCH OR
97760-8021
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-4621
  • Fax:
Mailing address:
  • Phone:
  • 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: AMY PUGH
Title or Position: MEMBER
Credential: DMD
Phone: 503-810-1173