Provider Demographics
NPI:1205213303
Name:PIONEER DENTAL GROUP PC
Entity Type:Organization
Organization Name:PIONEER DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALEIGH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PIOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-867-7179
Mailing Address - Street 1:19129 BEAVERCREEK RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9539
Mailing Address - Country:US
Mailing Address - Phone:503-305-5051
Mailing Address - Fax:503-342-6069
Practice Address - Street 1:19129 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9539
Practice Address - Country:US
Practice Address - Phone:503-305-5051
Practice Address - Fax:503-342-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty