MEDICARE: EAGLE POINT FAMILY DENTISTRY

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	D9308	OR

General Provider Information

NPI Number	:	1699164509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE POINT FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	11160 HIGHWAY 62 STE A
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-8025
Country	:	US
Telephone Number	:	541-826-0599
Fax Number	:	541-826-0602

Provider Business Practice Location Address
First Line	:	11160 HIGHWAY 62 STE A
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-8025
Country	:	US
Telephone Number	:	541-826-0599
Fax Number	:	541-826-0602

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LUKE BARSALOU
Credential	:	DMD
Telephone Number	:	541-826-0599

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “EAGLE POINT FAMILY DENTISTRY ” Practice Location

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