MEDICARE: OREGON ENDODONTICS 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	1223E0200X	Endodontics	D10144	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841553609	OTHER	OR	PERSONAL NPI

General Provider Information

NPI Number	:	1851764138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON ENDODONTICS LLC

Provider Business Mailing Address
First Line	:	196 CATRON ST N
Second Line	:
City	:	MONMOUTH
State	:	OR
Zip	:	97361-2303
Country	:	US
Telephone Number	:	503-400-4726
Fax Number	:	503-838-7210

Provider Business Practice Location Address
First Line	:	196 CATRON ST N
Second Line	:
City	:	MONMOUTH
State	:	OR
Zip	:	97361-2303
Country	:	US
Telephone Number	:	503-400-4726
Fax Number	:	503-838-7210

Authorized Official
Title or Position	:	SOLE MEMBER/ OWNER
Name	:	DR. RYAN HOMER SHURTZ
Credential	:	DDS, MS
Telephone Number	:	503-400-4726

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/09/2015

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Directions to “OREGON ENDODONTICS LLC ” Practice Location

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