MEDICARE: AWBREY DENTAL GROUP 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	D7490	OR
2	1223G0001X	General Practice Dentistry	D6909	OR

General Provider Information

NPI Number	:	1437302957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWBREY DENTAL GROUP PC

Provider Business Mailing Address
First Line	:	625 NW COLORADO AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-3257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 NW COLORADO AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-3257
Country	:	US
Telephone Number	:	541-383-0754
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PETER M YONAN
Credential	:
Telephone Number	:	541-383-0754

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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