Provider Demographics
NPI:1598219891
Name:BEST CARE DENTAL CENTER LLC
Entity Type:Organization
Organization Name:BEST CARE DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTBRESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-499-0292
Mailing Address - Street 1:1150 CRATER LAKE AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6213
Mailing Address - Country:US
Mailing Address - Phone:541-779-4517
Mailing Address - Fax:
Practice Address - Street 1:1150 CRATER LAKE AVE
Practice Address - Street 2:SUITE L
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6213
Practice Address - Country:US
Practice Address - Phone:541-779-4517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty