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General NPI Number Information
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NPI Number | 1790169217
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Entity Type | Organization
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Legal Business Name | ORTHO COUNTRY ORTHODONTICS LLC
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 1300 NE ALPHA DR
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City | MCMINNVILLE
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State | OR
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Zip | 97128-9711
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Country | US
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Telephone | 512-947-8916
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 NE ALPHA DR
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City | MCMINNVILLE
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State | OR
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Zip | 97128-9711
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Country | US
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Telephone | 512-947-8916
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KENT JENSEN
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Credential |
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Telephone | 503-472-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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