Provider Demographics
NPI:1629343140
Name:OREGON COMMUNITY DENTAL CARE
Entity Type:Organization
Organization Name:OREGON COMMUNITY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:R. MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRTCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:888-468-0022
Mailing Address - Street 1:442 SW UMATILLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7039
Mailing Address - Country:US
Mailing Address - Phone:888-468-0022
Mailing Address - Fax:541-504-3907
Practice Address - Street 1:671 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:OR
Practice Address - Zip Code:97496-6571
Practice Address - Country:US
Practice Address - Phone:888-468-0022
Practice Address - Fax:541-504-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty