Organization
SOUTH UMPQUA FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC CORNELIUS DDS (MANAGING MEMBER)
(541) 874-3126
Entity
Organization
Contact information
Practice address
150 MAIN STREET, RIDDLE, OR 97469
(541) 874-3126
(541) 874-3259
Mailing address
150 MAIN STREET, RIDDLE, OR 97469
(541) 874-3126
(541) 874-3259
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9281
OR
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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