Provider Demographics
NPI:1760420467
Name:ADC DENTAL CLINIC, INC
Entity Type:Organization
Organization Name:ADC DENTAL CLINIC, INC
Other - Org Name:ASTORIA DENTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-772-8280
Mailing Address - Street 1:720 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6722
Mailing Address - Country:US
Mailing Address - Phone:541-772-8280
Mailing Address - Fax:541-734-7771
Practice Address - Street 1:720 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6722
Practice Address - Country:US
Practice Address - Phone:541-772-8280
Practice Address - Fax:541-734-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8035122300000X
ORDT-DO849475122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered122400000XDental ProvidersDenturistGroup - Multi-Specialty