Organization
SISKIYOU COMMUNITY HEALTH CENTER INC
Active
Other names
Siskiyou Community Health Center Dental Facility
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BOOTH (CEO)
(541) 471-3455
Entity
Organization
Contact information
Practice address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1051
(541) 479-6393
(541) 479-6489
Mailing address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1051
(541) 479-6393
(541) 471-2024
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
H3448
OR
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/30/2008
Last updated
10/06/2021
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