Organization
SHULL FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEVI JAMES-OLIVER SHULL DMD (OWNER)
(971) 269-8004
Entity
Organization
Contact information
Practice address
1211 LIBERTY ST SE, SALEM, OR 97302-4243
(503) 362-5019
Mailing address
1211 LIBERTY ST SE, SALEM, OR 97302-4243
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140728500
OWNER
—
Enumeration date
06/18/2019
Last updated
07/23/2019
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