Healthcare Provider Details

I. General information

NPI: 1700152188
Provider Name (Legal Business Name): CRIS DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2377 OAKMONT WAY
EUGENE OR
97401-6459
US

IV. Provider business mailing address

3019 NW STEWART PKWY STE 304, #304
ROSEBURG OR
97471-1602
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-2747
  • Fax:
Mailing address:
  • Phone: 541-672-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J BRATLAND
Title or Position: OWNER
Credential: DMD
Phone: 541-672-2747