Provider Demographics
NPI:1598149791
Name:DIANNE D APPLEGATE DDS LLC
Entity Type:Organization
Organization Name:DIANNE D APPLEGATE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-775-9500
Mailing Address - Street 1:4840 SE CESAR E CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4017
Mailing Address - Country:US
Mailing Address - Phone:503-775-9500
Mailing Address - Fax:503-775-4026
Practice Address - Street 1:4840 SE CESAR E CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4017
Practice Address - Country:US
Practice Address - Phone:503-775-9500
Practice Address - Fax:503-775-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty