Individual
ERIC N DAHLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
478 SW 12TH ST, ONTARIO, OR 97914-3202
(541) 881-1794
(541) 889-2904
Mailing address
478 SW 12TH ST, ONTARIO, OR 97914-3202
(541) 881-1794
(541) 889-2904
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6574
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001716300
—
ID
05
—
095182
—
OR
01
—
6689990001
PTAN
—
Enumeration date
08/23/2005
Last updated
08/13/2012
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