Provider Demographics
NPI:1922160589
Name:SOUTHERN OREGON ENDODONTICS, PC
Entity Type:Organization
Organization Name:SOUTHERN OREGON ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-779-3324
Mailing Address - Street 1:2924 SISKIYOU BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8194
Mailing Address - Country:US
Mailing Address - Phone:541-779-3324
Mailing Address - Fax:541-779-3557
Practice Address - Street 1:2924 SISKIYOU BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8194
Practice Address - Country:US
Practice Address - Phone:541-779-3324
Practice Address - Fax:541-779-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty