Provider Demographics
NPI:1679849053
Name:CRIS DENTAL GROUP
Entity Type:Organization
Organization Name:CRIS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRATLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-672-2747
Mailing Address - Street 1:3019 NW STEWART PKWY
Mailing Address - Street 2:STE 304, #305
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1602
Mailing Address - Country:US
Mailing Address - Phone:541-672-2747
Mailing Address - Fax:541-672-2754
Practice Address - Street 1:5892 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5496
Practice Address - Country:US
Practice Address - Phone:541-672-2747
Practice Address - Fax:541-672-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty