Provider Demographics
NPI:1518070218
Name:WESTERN DENTURE CENTER INC.
Entity Type:Organization
Organization Name:WESTERN DENTURE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:541-773-3551
Mailing Address - Street 1:1055 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-5727
Mailing Address - Country:US
Mailing Address - Phone:541-773-3551
Mailing Address - Fax:541-776-4911
Practice Address - Street 1:1055 COURT ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5727
Practice Address - Country:US
Practice Address - Phone:541-773-3551
Practice Address - Fax:541-776-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-237679122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty