Healthcare Provider Details

I. General information

NPI: 1174341382
Provider Name (Legal Business Name): GOLD STANDARD DENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 LANCASTER DR NE
SALEM OR
97301-4728
US

IV. Provider business mailing address

432 LANCASTER DR NE
SALEM OR
97301-4728
US

V. Phone/Fax

Practice location:
  • Phone: 971-365-3900
  • Fax: 971-365-3500
Mailing address:
  • Phone: 971-365-3900
  • Fax: 971-365-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: MR. CODY MORGAN
Title or Position: DENTURIST
Credential: LD
Phone: 971-365-3900