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General NPI Number Information
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NPI Number | 1194938894
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Entity Type | Individual
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Provider Name | PHILLIP R DAHL L.D
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1663 W HARVARD AVE
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City | ROSEBURG
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State | OR
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Zip | 97470-2812
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Country | US
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Telephone | 541-672-0100
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Fax | 541-440-8996
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Provider Business Mailing Address
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Address Line | 14987 N BANK RD
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City | ROSEBURG
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State | OR
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Zip | 97470-7937
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Country | US
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Telephone | 541-496-3794
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DT DO 869528
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License Number State | OR
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