Healthcare Provider Details

I. General information

NPI: 1316051543
Provider Name (Legal Business Name): DAVID GEORGE NILES DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 CAL YOUNG RD
EUGENE OR
97401-6441
US

IV. Provider business mailing address

2555 CAL YOUNG RD
EUGENE OR
97401-6441
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-1943
  • Fax: 541-485-2496
Mailing address:
  • Phone: 541-484-1943
  • Fax: 541-485-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD7326
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: