Provider Demographics
NPI:1912035858
Name:ODS SCHOOL OF DENTAL SCHOOL OF DENTAL HYGIENE
Entity Type:Organization
Organization Name:ODS SCHOOL OF DENTAL SCHOOL OF DENTAL HYGIENE
Other - Org Name:ODS COLLEGE OF DENTAL SCIENCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEN PAX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-948-5544
Mailing Address - Street 1:909 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2570
Mailing Address - Country:US
Mailing Address - Phone:541-663-2720
Mailing Address - Fax:
Practice Address - Street 1:909 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2570
Practice Address - Country:US
Practice Address - Phone:541-663-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable