Provider Demographics
NPI:1508839929
Name:MICHAEL T DRYDEN DDS PC
Entity Type:Organization
Organization Name:MICHAEL T DRYDEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DRYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-484-0470
Mailing Address - Street 1:911 COUNTRY CLUB RD
Mailing Address - Street 2:STE 140
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-484-0470
Mailing Address - Fax:541-484-1552
Practice Address - Street 1:911 COUNTRY CLUB RD
Practice Address - Street 2:STE 140
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-484-0470
Practice Address - Fax:541-484-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD80441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty