Organization
STATEWIDE DENTAL SERVICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CEDRIC ROSS HAYDEN DDS (PRESIDENT)
(541) 393-7000
Entity
Organization
Contact information
Practice address
498 HARLOW RD STE 3, SPRINGFIELD, OR 97477-1339
(541) 393-7000
Mailing address
498 HARLOW RD STE 3, SPRINGFIELD, OR 97477-1339
(541) 393-7000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6958
OR
Other
Enumeration date
05/10/2010
Last updated
05/10/2010
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