Provider Demographics
NPI:1649584400
Name:MEDICAL CENTER DENTAL OFFICE, LLC
Entity Type:Organization
Organization Name:MEDICAL CENTER DENTAL OFFICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BENSCHOTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-276-1561
Mailing Address - Street 1:1100 SOUTHGATE STE 17
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3971
Mailing Address - Country:US
Mailing Address - Phone:541-276-1561
Mailing Address - Fax:541-276-5743
Practice Address - Street 1:1100 SOUTHGATE STE 17
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3971
Practice Address - Country:US
Practice Address - Phone:541-276-1561
Practice Address - Fax:541-276-5743
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
ORD5269261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental