Provider Demographics
NPI:1497196232
Name:OREGON PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:OREGON PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-698-4339
Mailing Address - Street 1:3140 DUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4341
Mailing Address - Country:US
Mailing Address - Phone:419-698-4339
Mailing Address - Fax:419-698-3484
Practice Address - Street 1:3140 DUSTIN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4341
Practice Address - Country:US
Practice Address - Phone:419-698-4339
Practice Address - Fax:419-698-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty