Organization
CENTENNIAL FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY LYNN GREGERSEN CDA, EFDA (OFFICE MANAGER)
(541) 741-0602
Entity
Organization
Contact information
Practice address
1290 W CENTENNIAL BLVD, SPRINGFIELD, OR 97477-3566
(541) 741-0602
(541) 741-0615
Mailing address
1290 W CENTENNIAL BLVD, SPRINGFIELD, OR 97477-3566
(541) 741-0602
(541) 741-0615
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/02/2024
Last updated
08/02/2024
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