Organization
OREGON DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD BRUBAKER (COO)
(815) 938-2575
Entity
Organization
Contact information
Practice address
1307 W WASHINGTON ST STE 130, OREGON, IL 61061-1001
(815) 732-6911
Mailing address
1307 W WASHINGTON ST STE 130, OREGON, IL 61061-1001
(815) 732-6911
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/03/2018
Last updated
08/03/2018
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