MEDICARE: 14TH AVENUE DENTAL LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1740707462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	14TH AVENUE DENTAL LLC

Provider Business Mailing Address
First Line	:	1025 BAIN ST SE STE B
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-5247
Country	:	US
Telephone Number	:	541-926-1303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 CEDARWOOD CT SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-6994
Country	:	US
Telephone Number	:	541-926-1303
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BENJAMIN JAMES
Credential	:	DDS
Telephone Number	:	541-666-6091

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	05/20/2025

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Directions to “14TH AVENUE DENTAL LLC ” Practice Location

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