Organization
UMPQUA COMMUNITY HEALTH CENTER, INC.
Active
Other names
Myrtle Creek Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KC BOLTON (CEO)
(541) 672-9596
Entity
Organization
Contact information
Practice address
244 NE DIVISION ST, MYRTLE CREEK, OR 97457-8507
(541) 672-9596
(541) 492-2060
Mailing address
150 NE KENNETH FORD DR, ROSEBURG, OR 97470-1042
(541) 672-9596
(541) 492-2060
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/14/2022
Last updated
10/14/2022
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