Provider Demographics
NPI:1780819284
Name:ASPEN DENTAL OF OREGON PC
Entity Type:Organization
Organization Name:ASPEN DENTAL OF OREGON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:DUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-463-4000
Mailing Address - Street 1:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3189
Mailing Address - Country:US
Mailing Address - Phone:315-454-6000
Mailing Address - Fax:315-454-8650
Practice Address - Street 1:2535 JORIE LN NE
Practice Address - Street 2:104
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4136
Practice Address - Country:US
Practice Address - Phone:503-463-4000
Practice Address - Fax:503-463-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR70251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty