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Organization

HARVARD ENDODONTICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SUSAN LESLIE LIESINGER (OFFICE MANAGER)
(541) 673-2383
Entity
Organization

Contact information

Practice address
1813 W. HARVARD AVE, SUITE 240, ROSEBURG, OR 97471-8708
(541) 673-2383
(541) 440-6319
Mailing address
1813 W. HARVARD AVE, SUITE 240, ROSEBURG, OR 97471-8708
(541) 673-2383
(541) 440-6319

Taxonomy

Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D5545
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
D5545
STATE LICENSE
OR
Enumeration date
10/01/2013
Last updated
10/01/2013
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