Provider Demographics
NPI:1336577824
Name:DR DONDO DENTAL EXCELLENCE LLC
Entity Type:Organization
Organization Name:DR DONDO DENTAL EXCELLENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:MARCEL
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-241-1299
Mailing Address - Street 1:1725 SW CHANDLER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3248
Mailing Address - Country:US
Mailing Address - Phone:541-241-1299
Mailing Address - Fax:541-389-1114
Practice Address - Street 1:1725 SW CHANDLER AVE STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3248
Practice Address - Country:US
Practice Address - Phone:541-241-1299
Practice Address - Fax:541-389-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84231223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty