Provider Demographics
NPI:1023032778
Name:SOUTHERN OREGON DENTAL L.L.C.
Entity Type:Organization
Organization Name:SOUTHERN OREGON DENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARRIGOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-476-7781
Mailing Address - Street 1:540 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5544
Mailing Address - Country:US
Mailing Address - Phone:541-476-7781
Mailing Address - Fax:541-471-9366
Practice Address - Street 1:540 UNION AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5544
Practice Address - Country:US
Practice Address - Phone:541-476-7781
Practice Address - Fax:541-471-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182634Medicaid