Organization
ELM STREET DENTAL LLC
Active
Other names
Elm Street Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANE S HARRIS DMD (MEMBER)
(541) 928-2993
Entity
Organization
Contact information
Practice address
1036 ELM ST SW, ALBANY, OR 97321-2039
(541) 928-2993
(541) 926-0339
Mailing address
1036 ELM ST SW, ALBANY, OR 97321-2039
(541) 928-2993
(541) 926-0339
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7193
OR
1223G0001X
General Practice Dentistry
D9733
OR
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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