# DENTISTRY FOR CHILDREN NW LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801902101
- **Authorized official:** MRS. LYNSEY B WICKWIRE (PRACTICE MANAGER)
- **Authorized official phone:** (541) 345-4076

## Contact information

- **Practice address:** 2215 WILLAMETTE ST A, EUGENE, OR 97405
- **Practice address phone:** (541) 345-4076
- **Practice address fax:** (541) 686-4834
- **Mailing address:** 2215 WILLAMETTE ST A, EUGENE, OR 97405
- **Mailing address phone:** (541) 345-4076
- **Mailing address fax:** (541) 686-4834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 5897 | OR | Yes |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5897 | BOARD OF DENTISTRY | OR |