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General NPI Number Information
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NPI Number | 1083986673
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Entity Type | Organization
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Legal Business Name | WILLIAM D. BETTIS, DMD, PC
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 1729 W HARVARD AVE SUITE 2
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City | ROSEBURG
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State | OR
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Zip | 97471-2788
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Country | US
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Telephone | 541-673-6344
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Fax | 541-673-9706
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Provider Business Mailing Address
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Address Line | PO BOX 1668
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City | ROSEBURG
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State | OR
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Zip | 97470-0408
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Country | US
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Telephone | 541-673-6344
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Fax | 541-673-9706
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM D BETTIS
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Credential | DMD
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Telephone | 541-673-6344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D4498
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License Number State | OR
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