Provider Demographics
NPI:1558099044
Name:MEMBERSPLUS DENTAL SPRINGFIELD
Entity Type:Organization
Organization Name:MEMBERSPLUS DENTAL SPRINGFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMSON ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-261-9539
Mailing Address - Street 1:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0360
Mailing Address - Country:US
Mailing Address - Phone:541-321-6238
Mailing Address - Fax:541-418-4311
Practice Address - Street 1:1847 PIONEER PKWY E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3907
Practice Address - Country:US
Practice Address - Phone:541-321-6238
Practice Address - Fax:541-418-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD11641OtherOREGON BOARD OF DENTISTRY
ORD11641OtherOREGON BOARD OF DENTISTRY