Provider Demographics
NPI:1851764138
Name:OREGON ENDODONTICS LLC
Entity Type:Organization
Organization Name:OREGON ENDODONTICS LLC
Other - Org Name:OREGON ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:HOMER
Authorized Official - Last Name:SHURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:503-400-4726
Mailing Address - Street 1:196 CATRON ST N
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-2303
Mailing Address - Country:US
Mailing Address - Phone:503-400-4726
Mailing Address - Fax:503-838-7210
Practice Address - Street 1:196 CATRON ST N
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-2303
Practice Address - Country:US
Practice Address - Phone:503-400-4726
Practice Address - Fax:503-838-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD101441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1841553609OtherPERSONAL NPI