Provider Demographics
NPI:1801216643
Name:WILLAMETTE VALLEY ENDODONTICS, PC
Entity type:Organization
Organization Name:WILLAMETTE VALLEY ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAI
Authorized Official - Middle Name:DOAN
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-378-1334
Mailing Address - Street 1:805 HIGH ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2442
Mailing Address - Country:US
Mailing Address - Phone:503-378-1334
Mailing Address - Fax:503-581-9464
Practice Address - Street 1:805 HIGH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2442
Practice Address - Country:US
Practice Address - Phone:503-378-1334
Practice Address - Fax:503-581-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-20
Last Update Date:2014-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty