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NPI Code Detail

MEDICARE: DENTAL PROFESSIONALS OF OREGON, P.C.

MEDICARE: DENTAL PROFESSIONALS OF OREGON, P.C.
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1497581516
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL PROFESSIONALS OF OREGON, P.C.
Provider Business Mailing Address
First Line : 1005 13TH ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-2506
Country : US
Telephone Number : 503-364-7232
Fax Number :
Provider Business Practice Location Address
First Line : 1005 13TH ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-2506
Country : US
Telephone Number : 503-364-7232
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : CEMYIRA MCDOUGAL
Credential :
Telephone Number : 217-764-8609
Provider Enumeration Date : 09/13/2024
Last Update Date : 09/13/2024

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Directions to “DENTAL PROFESSIONALS OF OREGON, P.C. ” Practice Location

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