Provider Demographics
NPI:1275894867
Name:OUS OREGON INSTITUTE OF TECHNOLOGY
Entity Type:Organization
Organization Name:OUS OREGON INSTITUTE OF TECHNOLOGY
Other - Org Name:OREGON TECH DENTAL HYGIENE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE AND ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-885-1106
Mailing Address - Street 1:4000 LANCASTER DRIVE NE
Mailing Address - Street 2:DENTAL HYGIENE 8/ 101
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305
Mailing Address - Country:US
Mailing Address - Phone:503-584-7101
Mailing Address - Fax:503-584-7105
Practice Address - Street 1:4000 LANCASTER DRIVE NE
Practice Address - Street 2:DENTAL HYGIENE 8/ 101
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305
Practice Address - Country:US
Practice Address - Phone:503-584-7101
Practice Address - Fax:503-584-7105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON UNIVERSITY SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental