Provider Demographics
NPI:1376751875
Name:BIGELOW AND PASTRELL DENTISTRY
Entity Type:Organization
Organization Name:BIGELOW AND PASTRELL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-476-4199
Mailing Address - Street 1:1050 SW GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-476-4199
Mailing Address - Fax:541-476-7166
Practice Address - Street 1:1050 SW GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-476-4199
Practice Address - Fax:541-476-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD72771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty