Provider Demographics
NPI:1659652683
Name:DENTAL REACH, INC.
Entity Type:Organization
Organization Name:DENTAL REACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILBER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:R D H
Authorized Official - Phone:503-329-9254
Mailing Address - Street 1:4427 NE 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1718
Mailing Address - Country:US
Mailing Address - Phone:503-329-9254
Mailing Address - Fax:
Practice Address - Street 1:4427 NE 49TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1718
Practice Address - Country:US
Practice Address - Phone:503-329-9254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-04
Last Update Date:2011-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5902124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty