Organization
VISTA ORTHODONTIC GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAIR H STRUBLE DMD, MSD (OWNER/ORTHODONTIST)
(541) 848-6642
Entity
Organization
Contact information
Practice address
400 SW BOND ST STE 300, BEND, OR 97702-3798
(541) 848-6642
(541) 848-6642
Mailing address
400 SW BOND ST STE 300, BEND, OR 97702-3798
(541) 848-6642
(541) 848-6649
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
12/17/2024
Last updated
12/17/2024
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