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General NPI Number Information
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NPI Number | 1144657594
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Entity Type | Organization
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Legal Business Name | HARVARD ENDODONTICS, LLC
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 1813 W. HARVARD AVE SUITE 240
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City | ROSEBURG
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State | OR
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Zip | 97471-8708
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Country | US
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Telephone | 541-673-2383
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Fax | 541-440-6319
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Provider Business Mailing Address
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Address Line | 1813 W. HARVARD AVE SUITE 240
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City | ROSEBURG
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State | OR
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Zip | 97471-8708
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Country | US
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Telephone | 541-673-2383
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Fax | 541-440-6319
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUSAN LESLIE LIESINGER
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Credential |
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Telephone | 541-673-2383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D5545
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License Number State | OR
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