Organization
EASTERN OREGON DENTAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC N DAHLE DMD (MEMBER)
(541) 881-1794
Entity
Organization
Contact information
Practice address
475 SW 12TH ST, ONTARIO, OR 97914-3201
(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
D6574
OR
122300000X
Dentist
D7219
OR
122300000X
Dentist
D9048
OR
1223E0200X
Endodontics
D6574
OR
1223E0200X
Endodontics
D7219
OR
1223E0200X
Endodontics
D9048
OR
1223G0001X
General Practice Dentistry
Primary
D6574
OR
1223G0001X
General Practice Dentistry
D7219
OR
1223G0001X
General Practice Dentistry
D9048
OR
1223P0300X
Periodontics
D6574
OR
1223P0300X
Periodontics
D7219
OR
1223P0300X
Periodontics
D9048
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D6574
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D7219
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9048
OR
Other
Enumeration date
05/14/2008
Last updated
05/14/2008
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