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General NPI Number Information
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NPI Number | 1194002725
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Entity Type | Organization
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Legal Business Name | ORAL HEALTH OUTREACH, LLC
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 4949 MEADOWS RD SUITE 475
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-4285
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Country | US
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Telephone | 503-702-1113
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Fax | 503-697-1990
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Provider Business Mailing Address
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Address Line | 4949 MEADOWS RD SUITE 475
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-4285
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Country | US
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Telephone | 503-702-1113
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Fax | 503-697-1990
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH FRANCIS MARKUNAS
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Credential |
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Telephone | 503-702-1113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D7025
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License Number State | OR
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