Provider Demographics
NPI:1457851495
Name:CLOUD NINE DENTAL CARE LLC
Entity Type:Organization
Organization Name:CLOUD NINE DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:DELLA CROCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-761-1529
Mailing Address - Street 1:8285 SW NIMBUS AVE STE 185
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8285 SW NIMBUS AVE STE 185
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6465
Practice Address - Country:US
Practice Address - Phone:267-761-1529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental