Healthcare Provider Details

I. General information

NPI: 1841047156
Provider Name (Legal Business Name): VICTOR LA VERNE GEHLING DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EASTERN OREGON CORRECTIONAL INSTITUTION 2500 WESTGATE
PENDLETON OR
97801
US

IV. Provider business mailing address

2500 WESTGATE
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-3622
  • Fax: 541-278-7158
Mailing address:
  • Phone: 541-278-3622
  • Fax: 541-278-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5568
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: