Provider Demographics
NPI:1952159618
Name:DENTAL HEALTH PROFESSIONALS OF OREGON, PC
Entity Type:Organization
Organization Name:DENTAL HEALTH PROFESSIONALS OF OREGON, PC
Other - Org Name:VALLEY VIEW DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMYIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-764-8609
Mailing Address - Street 1:1590 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4346
Mailing Address - Country:US
Mailing Address - Phone:503-399-7718
Mailing Address - Fax:
Practice Address - Street 1:1590 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4346
Practice Address - Country:US
Practice Address - Phone:503-399-7718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH PROFESSIONALS OF OREGON, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-08
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty