Provider Demographics
NPI:1366830341
Name:WARM SPRINGS DENTAL, LLC
Entity Type:Organization
Organization Name:WARM SPRINGS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EUZENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-421-6159
Mailing Address - Street 1:8220 SW WARM SPRINGS ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9338
Mailing Address - Country:US
Mailing Address - Phone:503-692-0337
Mailing Address - Fax:
Practice Address - Street 1:8220 SW WARM SPRINGS ST
Practice Address - Street 2:STE 200
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9338
Practice Address - Country:US
Practice Address - Phone:503-692-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty