Organization
APPLEGATE VALLEY DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R BOLDT DMD (SECRETARY)
(541) 899-7824
Entity
Organization
Contact information
Practice address
181 UPPER APPLEGATE RD, JACKSONVILLE, OR 97530-9739
(541) 899-7824
Mailing address
181 UPPER APPLEGATE RD, JACKSONVILLE, OR 97530-9739
(541) 899-7824
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6349
OR
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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