MEDICARE: SEA BRITE DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D6439	OR

General Provider Information

NPI Number	:	1063411437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA BRITE DENTAL PC

Provider Business Mailing Address
First Line	:	10609 S WALTON RD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850-8488
Country	:	US
Telephone Number	:	541-963-2741
Fax Number	:	541-963-7439

Provider Business Practice Location Address
First Line	:	10609 S WALTON RD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850-8488
Country	:	US
Telephone Number	:	541-963-2741
Fax Number	:	541-963-7439

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	MRS. CYNTHIA A MORRIS
Credential	:	DMD
Telephone Number	:	541-963-2741

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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