Organization
CRISDENTAL SALEM L.L.C.
Active
Parent organization
CRISDENTAL P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CRISDENTAL P.C.
Authorized official
MICHAEL J BRATLAND D.M.D. (OWNER)
(541) 672-2747
Entity
Organization
Contact information
Practice address
1355 EDGEWATER ST NW, SALEM, OR 97304-4077
(503) 588-6960
Mailing address
1333 W HARVARD AVE, ROSEBURG, OR 97471-2838
(541) 672-2747
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/07/2012
Last updated
05/07/2012
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