Healthcare Provider Details

I. General information

NPI: 1508839929
Provider Name (Legal Business Name): MICHAEL T DRYDEN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 COUNTRY CLUB RD STE 140
EUGENE OR
97401
US

IV. Provider business mailing address

911 COUNTRY CLUB RD STE 140
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-0470
  • Fax: 541-484-1552
Mailing address:
  • Phone: 541-484-0470
  • Fax: 541-484-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD8044
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MICHAEL THOMAS DRYDEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 541-484-0470