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General NPI Number Information
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NPI Number | 1700350493
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Entity Type | Organization
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Legal Business Name | CENTRAL DENTAL MONMOUTH LLC
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 120 ATWATER ST N
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City | MONMOUTH
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State | OR
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Zip | 97361-1801
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Country | US
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Telephone | 503-838-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 WILLETTA ST SW
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City | ALBANY
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State | OR
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Zip | 97321-3846
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Country | US
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Telephone | 541-928-2301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEOFFREY BERG
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Credential | DMD
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Telephone | 541-928-2301
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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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