Organization
BASIN DENTAL CARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OWEN JEFFREY LEROY D.M.D. (OWNER/DENTIST)
(541) 884-4550
Entity
Organization
Contact information
Practice address
2530 SHASTA WAY, KLAMATH FALLS, OR 97601-4356
(541) 884-4550
(541) 884-4676
Mailing address
2530 SHASTA WAY, KLAMATH FALLS, OR 97601-4356
(541) 884-4550
(541) 884-4676
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4448
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10844-9
—
OR
Enumeration date
02/19/2008
Last updated
02/19/2008
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