Provider Demographics
NPI:1902022783
Name:ENDODONTIC SPECIALTY GROUP, P.C.
Entity Type:Organization
Organization Name:ENDODONTIC SPECIALTY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-665-0495
Mailing Address - Street 1:1550 NW EASTMAN PKWY
Mailing Address - Street 2:SUITE 265
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3858
Mailing Address - Country:US
Mailing Address - Phone:503-665-0495
Mailing Address - Fax:503-674-9196
Practice Address - Street 1:1550 NW EASTMAN PKWY
Practice Address - Street 2:SUITE 265
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3858
Practice Address - Country:US
Practice Address - Phone:503-665-0495
Practice Address - Fax:503-674-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1861561508OtherDALE R. BARKER DDS
HI1265505408OtherJON D. YATSUSHIRO, DDS
CA1932296761OtherMARK D. DANIELSON, DDS