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Organization
SANDCREEK DENTAL LLC
Active
Organization
SANDCREEK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYRUS JAVADI DDS (SOLE MEMBER)
(503) 801-5363
Entity
Organization
Contact information
Practice address
1115 MAIN AVE, TILLAMOOK, OR 97141-3819
(503) 842-7788
Mailing address
1115 MAIN AVE, TILLAMOOK, OR 97141-3819
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9114
OR
Other
Enumeration date
05/01/2012
Last updated
05/01/2012
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