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General NPI Number Information
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NPI Number | 1437713252
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Entity Type | Organization
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Legal Business Name | VENETA FAMILY DENTAL
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 25078 HUNTER RD
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City | VENETA
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State | OR
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Zip | 97487
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Country | US
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Telephone | 541-935-2113
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Fax | 541-935-5864
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Provider Business Mailing Address
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Address Line | P.O. BOX 1389
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City | VENETA
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State | OR
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Zip | 97487
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Country | US
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Telephone | 541-935-2133
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Fax | 541-935-5864
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TRACY ROBINSON
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Credential | DMD
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Telephone | 541-935-2113
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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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