Provider Demographics
NPI:1669410577
Name:RICHARD C. DOWLING DMD LLC
Entity type:Organization
Organization Name:RICHARD C. DOWLING DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-347-4461
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-0720
Mailing Address - Country:US
Mailing Address - Phone:541-347-4461
Mailing Address - Fax:541-347-9152
Practice Address - Street 1:725 2ND ST SE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9420
Practice Address - Country:US
Practice Address - Phone:541-347-4461
Practice Address - Fax:541-347-9152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD82491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORV08381Medicare UPIN
OR133992Medicare PIN