Organization
GREYSLAK DENTAL LLC
Active
Other names
Corvallis Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSE GREYSLAK DMD (DENTIST)
(503) 830-3812
Entity
Organization
Contact information
Practice address
2318 NW KINGS BLVD, CORVALLIS, OR 97330-3925
(541) 754-6116
Mailing address
3553 SW PAR PL, CORVALLIS, OR 97333-1160
(503) 830-3812
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10104
OR
1223G0001X
General Practice Dentistry
D10127
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417358961
JASON GREYSLAK
OR
Enumeration date
07/02/2018
Last updated
07/02/2018
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