Provider Demographics
NPI:1093087884
Name:CEDAR HILLS DENTAL, LLC
Entity Type:Organization
Organization Name:CEDAR HILLS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:F
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-469-8404
Mailing Address - Street 1:12745 SW WALKER RD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1318
Mailing Address - Country:US
Mailing Address - Phone:503-469-8404
Mailing Address - Fax:503-469-9305
Practice Address - Street 1:12745 SW WALKER RD
Practice Address - Street 2:SUITE #400
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1318
Practice Address - Country:US
Practice Address - Phone:503-469-8404
Practice Address - Fax:503-469-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty