Healthcare Provider Details

I. General information

NPI: 1174520548
Provider Name (Legal Business Name): MARTIN J. MEHR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RAMSGATE SQ S SUITE 110
SALEM OR
97302-5868
US

IV. Provider business mailing address

120 RAMSGATE SQ S SUITE 110
SALEM OR
97302-5868
US

V. Phone/Fax

Practice location:
  • Phone: 503-371-6000
  • Fax: 503-363-8340
Mailing address:
  • Phone: 503-371-6000
  • Fax: 503-363-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD5821
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: