Provider Demographics
NPI:1023729969
Name:BREATHE DEEP DENTAL LLC
Entity type:Organization
Organization Name:BREATHE DEEP DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:ROSE MORRELL
Authorized Official - Last Name:DIEPENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-262-6101
Mailing Address - Street 1:548 NW HARMON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3022
Mailing Address - Country:US
Mailing Address - Phone:541-419-6567
Mailing Address - Fax:
Practice Address - Street 1:61583 SE 27TH ST
Practice Address - Street 2:SUITE TBD
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-262-6101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental