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Organization
SOUTH UMPQUA FAMILY DENTAL PC
Active
Organization
SOUTH UMPQUA FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC D CORNELIUS DDS (PRESIDENT/SECRETARY)
(541) 874-3126
Entity
Organization
Contact information
Practice address
150 MAIN STREET, RIDDLE, OR 97469-0107
(541) 874-3126
(541) 874-3259
Mailing address
PO BOX 107, RIDDLE, OR 97469-0107
(541) 874-3126
(541) 874-3259
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9281
OR
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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