Provider Demographics
NPI:1356675938
Name:ASTORIA DENTAL CLINIC
Entity Type:Organization
Organization Name:ASTORIA DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:EPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-479-7199
Mailing Address - Street 1:820 NE E STREET SUITE E
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-479-7199
Mailing Address - Fax:541-471-6086
Practice Address - Street 1:820 NE E STREET SUITE E
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-479-7199
Practice Address - Fax:541-471-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental