Provider Demographics
NPI:1114665890
Name:AUMSVILLE FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:AUMSVILLE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-437-5075
Mailing Address - Street 1:1076 GINGER AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9806
Mailing Address - Country:US
Mailing Address - Phone:503-437-5075
Mailing Address - Fax:
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUMSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97325-9806
Practice Address - Country:US
Practice Address - Phone:503-877-1594
Practice Address - Fax:503-448-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1649684382OtherNPI
OR1609485101OtherNPI