Healthcare Provider Details

I. General information

NPI: 1124172911
Provider Name (Legal Business Name): DENTURE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E 14TH AVE
EUGENE OR
97401-4166
US

IV. Provider business mailing address

202 E 14TH AVE
EUGENE OR
97401-4166
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-2050
  • Fax: 541-687-0163
Mailing address:
  • Phone: 541-687-2050
  • Fax: 541-687-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number0516846206
License Number StateOR

VIII. Authorized Official

Name: SHAWN M MURRAY
Title or Position: OWNER
Credential: C.D.T., L.D.
Phone: 541-687-2050