Healthcare Provider Details

I. General information

NPI: 1760420467
Provider Name (Legal Business Name): ADC DENTAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BENNETT AVE
MEDFORD OR
97504-6722
US

IV. Provider business mailing address

720 BENNETT AVE
MEDFORD OR
97504-6722
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-8280
  • Fax: 541-734-7771
Mailing address:
  • Phone: 541-772-8280
  • Fax: 541-734-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8035
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDT-DO849475
License Number StateOR

VIII. Authorized Official

Name: BECKY L EPLETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-772-8280