Provider Demographics
NPI:1760526255
Name:OAK PARK FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:OAK PARK FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-588-7800
Mailing Address - Street 1:4175 SILVERTON RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2054
Mailing Address - Country:US
Mailing Address - Phone:503-588-7800
Mailing Address - Fax:503-391-0762
Practice Address - Street 1:4175 SILVERTON RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2054
Practice Address - Country:US
Practice Address - Phone:503-588-7800
Practice Address - Fax:503-391-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD62931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty