Provider Demographics
NPI:1285633248
Name:ST. HELENS DENTAL CARE
Entity Type:Organization
Organization Name:ST. HELENS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYDE
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-397-3326
Mailing Address - Street 1:575 S COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:ST HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2835
Mailing Address - Country:US
Mailing Address - Phone:503-397-3326
Mailing Address - Fax:503-397-1150
Practice Address - Street 1:575 S COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:ST HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2835
Practice Address - Country:US
Practice Address - Phone:503-397-3326
Practice Address - Fax:503-397-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD-7183 AND D-80751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty