Healthcare Provider Details

I. General information

NPI: 1649677477
Provider Name (Legal Business Name): MARGARET GIRUC DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 12TH ST SE
SALEM OR
97301-4001
US

IV. Provider business mailing address

630 12TH ST SE
SALEM OR
97301-4001
US

V. Phone/Fax

Practice location:
  • Phone: 503-581-2446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8053
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARGARET GIRUC
Title or Position: OWNER
Credential: DDS
Phone: 503-581-2446