Organization
ROGUE VALLEY FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW DALE GORDON (BUISNESS MANAGER)
(541) 269-5353
Entity
Organization
Contact information
Practice address
1873 WILLIAMS HWY STE 1A, GRANTS PASS, OR 97527-5843
(541) 479-5505
(541) 479-7891
Mailing address
1250 THOMPSON RD, COOS BAY, OR 97420-2538
(541) 269-5353
(541) 266-0933
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D9399
OR
1223G0001X
General Practice Dentistry
D9604
OR
1223G0001X
General Practice Dentistry
Primary
D9619
OR
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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