Organization
ADVANTAGE LAPINE QALICB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE DYSERT (EXECUTIVE VP OF OPERATIONS)
(541) 504-3900
Entity
Organization
Contact information
Practice address
442 SW UMATILLA AVE STE 200, REDMOND, OR 97756-7039
(541) 504-3900
Mailing address
442 SW UMATILLA AVE STE 200, REDMOND, OR 97756-7039
(541) 504-3900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4459
OR
Other
Enumeration date
01/06/2014
Last updated
01/06/2014
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