Organization
MID-VALLEY DENTAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M. BAHAM (OFFICE MANAGER)
(541) 928-2301
Entity
Organization
Contact information
Practice address
2825 WILLETTA ST SW, SUITE A, ALBANY, OR 97321-3846
(541) 928-2301
(541) 928-8493
Mailing address
2825 WILLETTA ST SW, SUITE A, ALBANY, OR 97321-3846
(541) 928-2301
(541) 928-8493
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7915
OR
1223G0001X
General Practice Dentistry
D8673
OR
1223G0001X
General Practice Dentistry
D9084
OR
1223G0001X
General Practice Dentistry
D9107
OR
Other
Enumeration date
04/07/2009
Last updated
04/07/2009
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