Provider Demographics
NPI:1073774113
Name:OEPACKARDDDSPLLC
Entity Type:Organization
Organization Name:OEPACKARDDDSPLLC
Other - Org Name:RIVER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-566-1400
Mailing Address - Street 1:9013 NE HIGHWAY 99
Mailing Address - Street 2:SUITE M
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8942
Mailing Address - Country:US
Mailing Address - Phone:360-566-1400
Mailing Address - Fax:360-566-1402
Practice Address - Street 1:9013 NE HIGHWAY 99
Practice Address - Street 2:SUITE M
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8942
Practice Address - Country:US
Practice Address - Phone:360-566-1400
Practice Address - Fax:360-566-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty