Provider Demographics
NPI:1598972903
Name:CASCADE DENTAL
Entity Type:Organization
Organization Name:CASCADE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:G.M.P
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-344-6058
Mailing Address - Street 1:PO BOX 25012
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0445
Mailing Address - Country:US
Mailing Address - Phone:541-344-6058
Mailing Address - Fax:541-343-9686
Practice Address - Street 1:1800 VALLEY RIVER DR
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6714
Practice Address - Country:US
Practice Address - Phone:541-344-6058
Practice Address - Fax:541-343-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty