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General NPI Number Information
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NPI Number | 1730412149
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Entity Type | Organization
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Legal Business Name | OREGON PIP DENTAL GROUP, PC
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 419 STATE ST STE 4
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City | HOOD RIVER
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State | OR
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Zip | 97031-2075
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Country | US
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Telephone | 541-387-8688
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Fax | 541-387-6785
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Provider Business Mailing Address
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Address Line | 419 STATE ST STE 4
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City | HOOD RIVER
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State | OR
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Zip | 97031-2075
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Country | US
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Telephone | 541-387-8688
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Fax | 541-387-6785
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Authorized Official
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Title or Position | REGIONAL OPERATION MANAGER
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Name | MELLISSA RENNER
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Credential |
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Telephone | 541-571-7145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D7666
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License Number State | OR
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