Provider Demographics
NPI:1205536125
Name:ACORN DENTISTRY FOR KIDS - ORTHODONTICS
Entity type:Organization
Organization Name:ACORN DENTISTRY FOR KIDS - ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SLAVENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-990-5088
Mailing Address - Street 1:110 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1745
Mailing Address - Country:US
Mailing Address - Phone:503-874-4560
Mailing Address - Fax:
Practice Address - Street 1:799 LANCASTER DR NE STE 140
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5235
Practice Address - Country:US
Practice Address - Phone:503-400-6674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACORN DENTISTRY FOR KIDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty