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NPI Code Detail

MEDICARE: MILL CREEK DENTAL, INC.

MEDICARE: MILL CREEK DENTAL, INC.
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 DentistryD6854OR

General Provider Information

NPI Number : 1497823546
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILL CREEK DENTAL, INC.
Provider Business Mailing Address
First Line : 521 N 1ST AVE
Second Line :
City : STAYTON
State : OR
Zip : 97383-1703
Country : US
Telephone Number : 503-769-9699
Fax Number : 503-769-8599
Provider Business Practice Location Address
First Line : 521 N 1ST AVE
Second Line :
City : STAYTON
State : OR
Zip : 97383-1703
Country : US
Telephone Number : 503-769-9699
Fax Number : 503-769-8599
Authorized Official
Title or Position : PRESIDENT
Name : DR. TIMOTHY WILLLIAM BURNS
Credential : D.D.S.
Telephone Number : 503-769-9699
Provider Enumeration Date : 11/30/2006
Last Update Date : 08/22/2020

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Directions to “MILL CREEK DENTAL, INC. ” Practice Location

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