Provider Demographics
NPI:1669742441
Name:STRUBLE ORTHODONTICS, LLC
Entity type:Organization
Organization Name:STRUBLE ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:STRUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:541-848-6642
Mailing Address - Street 1:1475 SW CHANDLER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3240
Mailing Address - Country:US
Mailing Address - Phone:541-848-6642
Mailing Address - Fax:
Practice Address - Street 1:1475 SW CHANDLER AVE STE 202
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3240
Practice Address - Country:US
Practice Address - Phone:541-848-6642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty