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General NPI Number Information
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NPI Number | 1205519881
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Entity Type | Organization
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Legal Business Name | MAPLE DENTAL
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 410 E ELLENDALE AVE STE 4
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City | DALLAS
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State | OR
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Zip | 97338-3052
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Country | US
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Telephone | 971-900-9163
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Fax |
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Provider Business Mailing Address
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Address Line | 410 E ELLENDALE AVE STE 4
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City | DALLAS
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State | OR
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Zip | 97338-3052
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Country | US
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Telephone | 971-900-9163
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BENJAMIN JAMES
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Credential | DDS
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Telephone | 541-666-6091
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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 |
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License Number State |
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