Provider Demographics
NPI:1629382585
Name:SPRINGWATER DENTAL
Entity Type:Organization
Organization Name:SPRINGWATER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-228-5059
Mailing Address - Street 1:8325 SE HARNEY ST.
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266
Mailing Address - Country:US
Mailing Address - Phone:503-228-5059
Mailing Address - Fax:503-517-2808
Practice Address - Street 1:8325 SE HARNEY ST.
Practice Address - Street 2:SUITE #101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266
Practice Address - Country:US
Practice Address - Phone:503-228-5059
Practice Address - Fax:503-517-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8126261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental