Organization
CORVALLIS DENTAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH A SLACK (OFFICE MANAGER)
(541) 754-6116
Entity
Organization
Contact information
Practice address
2318 NW KINGS BLVD, CORVALLIS, OR 97330-3925
(541) 754-6116
(541) 753-3616
Mailing address
2318 NW KINGS BLVD, CORVALLIS, OR 97330-3925
(541) 754-6116
(541) 753-3616
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D54041
OR
1223G0001X
General Practice Dentistry
D6074
OR
Other
Enumeration date
07/20/2006
Last updated
08/22/2020
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