Provider Demographics
NPI:1245359033
Name:OREGON INSTITUTE OF TECHNOLOGY
Entity type:Organization
Organization Name:OREGON INSTITUTE OF TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENE DEPARTMENT CHAIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:541-885-1352
Mailing Address - Street 1:3201 CAMPUS DR
Mailing Address - Street 2:DENTAL HYGIENE CLINIC
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-8801
Mailing Address - Country:US
Mailing Address - Phone:541-885-1330
Mailing Address - Fax:541-851-5301
Practice Address - Street 1:3201 CAMPUS DR
Practice Address - Street 2:DENTAL HYGIENE CLINIC
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-8801
Practice Address - Country:US
Practice Address - Phone:541-885-1330
Practice Address - Fax:541-851-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORZ426390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty