Individual
DR. PHILLIP BRUCE LASSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
21978 HWY 62, SHADY COVE, OR 97539-1236
(541) 878-2115
(541) 878-2117
Mailing address
PO BOX 1236, SHADY COVE, OR 97539-1236
(541) 878-2115
(541) 878-2117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5966
OR
Other
Enumeration date
08/16/2006
Last updated
07/08/2007
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