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General NPI Number Information
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NPI Number | 1346831096
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Entity Type | Organization
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Legal Business Name | LINCOLN CITY FAMILY DENTAL LLC
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 1120 SE 1ST ST
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City | LINCOLN CITY
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State | OR
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Zip | 97367-2803
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Country | US
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Telephone | 541-994-8935
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Fax |
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Provider Business Mailing Address
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Address Line | 5910 SW ARBOR DR
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City | SOUTH BEACH
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State | OR
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Zip | 97366-9660
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANA MATLOCK
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Credential | DDS
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Telephone | 361-645-9652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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