MEDICARE: DR. CATHERINE MARIE DAHL DMD

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	DE60295941	WA

General Provider Information

NPI Number	:	1063763076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE MARIE DAHL DMD

Provider Business Mailing Address
First Line	:	1296 COMMERCIAL ST SE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4200
Country	:	US
Telephone Number	:	503-399-0724
Fax Number	:	971-900-5777

Provider Business Practice Location Address
First Line	:	1296 COMMERCIAL ST SE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4200
Country	:	US
Telephone Number	:	503-399-0724
Fax Number	:	971-900-5777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/14/2022

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