Organization
EMERALD DENTURE CENTER INC
Active
Other names
Rustys Denture Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT ANSELMO CACCIVIO JR. CD LD RDH (PRESIDENT DENTURIST)
(541) 461-2020
Entity
Organization
Contact information
Practice address
905 RIVER RD, EUGENE, OR 97404
(541) 461-2020
Mailing address
905 RIVER RD, EUGENE, OR 97404
(541) 461-2020
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DTDO461580
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066662
ADULT & FAMILY SERVICE
OR
Enumeration date
04/30/2007
Last updated
08/22/2020
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