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General NPI Number Information
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NPI Number | 1700174182
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Entity Type | Organization
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Legal Business Name | NEARINGMAYES, LLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 1614 5TH ST
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City | LA GRANDE
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State | OR
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Zip | 97850-2516
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Country | US
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Telephone | 541-963-8585
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Fax | 541-963-6633
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Provider Business Mailing Address
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Address Line | 1614 5TH ST
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City | LA GRANDE
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State | OR
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Zip | 97850-2516
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Country | US
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Telephone | 541-963-8585
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Fax | 541-963-6633
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Authorized Official
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Title or Position | DENTIST/ MANAGER
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Name | DR. PATRICK M NEARING
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Credential | DMD
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Telephone | 541-963-8585
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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 | 5543
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License Number State | OR
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