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Organization

MOUNTAIN VALLEY DENTAL GROUP P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIRSTEN HARRISON (BUSINESS MANAGER)
(541) 567-8414
Entity
Organization

Contact information

Practice address
3980 MIDWAY DR, BAKER CITY, OR 97814-1453
(541) 523-6311
(541) 523-6312
Mailing address
1050 W ELM AVE STE 240, HERMISTON, OR 97838-2714
(541) 567-8414
(541) 567-8422

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8800
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
241313
OR
Enumeration date
07/16/2009
Last updated
07/16/2009
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