Organization
IDYLWOOD DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDGAR MERZENICH DMD (CLINICAL DIRECTOR)
(503) 315-2500
Entity
Organization
Contact information
Practice address
4392 LIBERTY ROAD, SALEM, OR 97302-6171
(503) 315-2500
(503) 315-7227
Mailing address
PO BOX 3000, SALEM, OR 97302-8001
(800) 544-2345
(503) 315-7227
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4063
OR
Other
Enumeration date
06/20/2018
Last updated
06/20/2018
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