Provider Demographics
NPI:1972924215
Name:DALLES DENTAL CARE LLC
Entity Type:Organization
Organization Name:DALLES DENTAL CARE LLC
Other - Org Name:THE DALLES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EASLING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-298-4411
Mailing Address - Street 1:501 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2677
Mailing Address - Country:US
Mailing Address - Phone:541-298-4411
Mailing Address - Fax:541-298-7798
Practice Address - Street 1:501 E 7TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2677
Practice Address - Country:US
Practice Address - Phone:541-298-4411
Practice Address - Fax:541-298-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9606261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental