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Organization

UME CRATER LAKE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SEAN WASDEN (COO)
(208) 965-9415
Entity
Organization

Contact information

Practice address
1094 ROYAL CT, MEDFORD, OR 97504-6138
(541) 779-4344
Mailing address
624 3RD ST S, NAMPA, ID 83651-3840
(208) 965-9415

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
05/19/2023
Last updated
05/19/2023
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