Provider Demographics
NPI:1457926834
Name:MILL CREEK DENTAL LLC
Entity Type:Organization
Organization Name:MILL CREEK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-928-2301
Mailing Address - Street 1:2825 WILLETTA ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3846
Mailing Address - Country:US
Mailing Address - Phone:541-928-2301
Mailing Address - Fax:541-928-8493
Practice Address - Street 1:848 COMMERCIAL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1016
Practice Address - Country:US
Practice Address - Phone:503-362-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-VALLEY DENTAL ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty