Organization
DENTISTRY FOR CHILDREN NW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNSEY B WICKWIRE (PRACTICE MANAGER)
(541) 345-4076
Entity
Organization
Contact information
Practice address
2215 WILLAMETTE ST A, EUGENE, OR 97405
(541) 345-4076
(541) 686-4834
Mailing address
2215 WILLAMETTE ST A, EUGENE, OR 97405
(541) 345-4076
(541) 686-4834
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5897
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5897
BOARD OF DENTISTRY
OR
Enumeration date
08/21/2006
Last updated
08/22/2020
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