Provider Demographics
NPI:1477049674
Name:DENTAL PROFESSIONALS OF OREGON, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF OREGON, P.C.
Other - Org Name:SUNRIDGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8426
Mailing Address - Street 1:14679 SE SUNNYSIDE RD STE D
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6507
Mailing Address - Country:US
Mailing Address - Phone:503-427-9528
Mailing Address - Fax:
Practice Address - Street 1:14679 SE SUNNYSIDE RD STE D
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:217-540-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF OREGON, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-11
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty