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NPI Code Detail

MEDICARE: DR. KREGG LEE DELANGE DMD

MEDICARE: DR. KREGG LEE DELANGE DMD
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
1122300000XDentistD7810OR

General Provider Information

NPI Number : 1841209038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KREGG LEE DELANGE DMD
Provider Business Mailing Address
First Line : 2300 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97305-1223
Country : US
Telephone Number : 503-370-4313
Fax Number :
Provider Business Practice Location Address
First Line : 2300 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97305-1223
Country : US
Telephone Number : 503-370-4313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/08/2007

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Directions to “ DR. KREGG LEE DELANGE DMD” Practice Location

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