Organization
ROGUE VALLEY DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH BERG (OWNER)
(541) 779-4517
Entity
Organization
Contact information
Practice address
1150 CRATER LAKE AVE, STE E, MEDFORD, OR 97504-6213
(541) 779-4517
(541) 779-4605
Mailing address
1150 CRATER LAKE AVE, STE E, MEDFORD, OR 97504-6213
(541) 779-4517
(541) 779-4605
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4310
OR
1223G0001X
General Practice Dentistry
D4738
OR
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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