Provider Demographics
NPI:1265698351
Name:CASCADE ENDODONTIC GROUP LLC
Entity type:Organization
Organization Name:CASCADE ENDODONTIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-388-1500
Mailing Address - Street 1:1590 NE WILLIAMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6071
Mailing Address - Country:US
Mailing Address - Phone:541-388-1500
Mailing Address - Fax:541-388-6995
Practice Address - Street 1:1590 NE WILLIAMSON BLVD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6071
Practice Address - Country:US
Practice Address - Phone:541-388-1500
Practice Address - Fax:541-388-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84901223E0200X
ORD82111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty