Provider Demographics
NPI:1437313251
Name:PACIFIC UNIVERSITY DENTAL HEALTH
Entity Type:Organization
Organization Name:PACIFIC UNIVERSITY DENTAL HEALTH
Other - Org Name:SCHOOL OF DENTAL HEALTH SCIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:V
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-352-7238
Mailing Address - Street 1:222 SE 8TH AVE
Mailing Address - Street 2:STE 271
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4218
Mailing Address - Country:US
Mailing Address - Phone:503-352-7373
Mailing Address - Fax:
Practice Address - Street 1:222 SE 8TH AVE
Practice Address - Street 2:STE 271
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-352-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6214251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare