Provider Demographics
NPI:1679091078
Name:OREGON INSTITUTE OF TECHNOLOGY
Entity Type:Organization
Organization Name:OREGON INSTITUTE OF TECHNOLOGY
Other - Org Name:OREGON TECH DENTAL CLINIC-KLAMATH FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTS OFFICER AND LEGAL LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:503-821-1266
Mailing Address - Street 1:3201 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-8801
Mailing Address - Country:US
Mailing Address - Phone:541-885-1000
Mailing Address - Fax:
Practice Address - Street 1:3201 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-8801
Practice Address - Country:US
Practice Address - Phone:541-885-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON INSTITUTE OF TECHMOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty