Provider Demographics
NPI:1669467916
Name:V2 FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:V2 FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VAN VOORHIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-569-0953
Mailing Address - Street 1:398 NE NORTON LN
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8481
Mailing Address - Country:US
Mailing Address - Phone:503-569-0953
Mailing Address - Fax:503-463-6141
Practice Address - Street 1:398 NE NORTON LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8481
Practice Address - Country:US
Practice Address - Phone:503-569-0953
Practice Address - Fax:503-463-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74051223G0001X
ORD73491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty