Organization
CRISDENTAL LINCOLN CITY, LLC
Active
Parent organization
CRISDENTAL PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CRISDENTAL PC
Authorized official
DR. MICHAEL J BRATLAND DMD (OWNER)
(541) 492-1687
Entity
Organization
Contact information
Practice address
2604 NE HIGHWAY 101, LINCOLN CITY, OR 97367-4460
(541) 492-1687
Mailing address
PO BOX 1361, ROSEBURG, OR 97470-0334
(541) 492-1687
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8594
OR
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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