Organization
MOSAIC MEDICAL DENTAL
Active
Parent organization
MOSAIC MEDICAL
Other names
Mosaic Medical Bend Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOSAIC MEDICAL
Authorized official
MEGAN HAASE (CEO)
(541) 383-3005
Entity
Organization
Contact information
Practice address
2084 NE PROFESSIONAL CT, BEND, OR 97701-6077
(541) 383-3005
(541) 383-1883
Mailing address
600 SW COLUMBIA ST STE 6210, BEND, OR 97702-1099
(541) 383-3005
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182960
—
OR
Enumeration date
01/04/2018
Last updated
02/28/2018
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