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General NPI Number Information
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NPI Number | 1801110994
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Entity Type | Organization
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Legal Business Name | WOODBURN COSMETIC & FAMILY DENTISTRY P.C.
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1018 N. BOONES FERRY RD.
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City | WOODBURN
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State | OR
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Zip | 97071
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Country | US
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Telephone | 503-981-1841
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Fax | 503-981-7334
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Provider Business Mailing Address
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Address Line | 1018 N. BOONES FERRY RD.
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City | WOODBURN
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State | OR
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Zip | 97071
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Country | US
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Telephone | 503-981-1841
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Fax | 503-981-7334
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN BLAKLEY
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Credential | D.M.D.
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Telephone | 503-981-1841
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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 | D6259
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License Number State | OR
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