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General NPI Number Information
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NPI Number | 1184831083
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF SALEM LLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2020 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-5208
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Country | US
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Telephone | 503-364-7545
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Fax | 503-540-7911
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Provider Business Mailing Address
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Address Line | 2020 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-5208
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Country | US
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Telephone | 503-364-7545
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Fax | 503-540-7911
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Authorized Official
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Title or Position | PARTNER
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Name | DR. WESTON WILLARD HERINGER III
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Credential | D.M.D.
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Telephone | 503-364-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4631
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7703
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License Number State | OR
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