Provider Demographics
NPI:1023223732
Name:DESCHUTES PEDIATRIC DENTISTRY PC
Entity Type:Organization
Organization Name:DESCHUTES PEDIATRIC DENTISTRY PC
Other - Org Name:DESCHUTES PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-389-3073
Mailing Address - Street 1:1475 SW CHANDLER AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1475 SW CHANDLER AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3238
Practice Address - Country:US
Practice Address - Phone:541-389-9642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental