Organization
EAST MAIN DENTAL CENTER, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONYA LYNN SOWLES (OFFICE MANAGER)
(541) 773-3422
Entity
Organization
Contact information
Practice address
1123 E MAIN ST, MEDFORD, OR 97504-7434
(541) 773-3422
(541) 779-2250
Mailing address
1123 E MAIN ST, MEDFORD, OR 97504-7434
(541) 773-3422
(541) 779-2250
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5563
OR
1223G0001X
General Practice Dentistry
6025
OR
1223G0001X
General Practice Dentistry
D6571
OR
1223G0001X
General Practice Dentistry
D6735
OR
1223G0001X
General Practice Dentistry
Primary
D7789
OR
1223G0001X
General Practice Dentistry
D8765
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04407-3
OMAP PROVIDER NUMBER
OR
01
—
08594-9
OMAP PROVIDER NUMBER
OR
01
—
21816-4
OMAP PROVIDER
OR
01
—
22707-2
OMAP PROVIDER NUMBER
OR
01
—
28445-5
OMAP PROVIDER NUMBER
OR
Enumeration date
07/08/2006
Last updated
08/22/2020
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