Provider Demographics
NPI:1790083509
Name:WILLIAM M. SOPER, DDS
Entity Type:Organization
Organization Name:WILLIAM M. SOPER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-347-4321
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-0470
Mailing Address - Country:US
Mailing Address - Phone:541-347-4321
Mailing Address - Fax:541-347-4321
Practice Address - Street 1:1275 OREGON AVE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411
Practice Address - Country:US
Practice Address - Phone:541-347-4321
Practice Address - Fax:541-347-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4777305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization