Organization
ADVANTAGE DENTAL GROUP, PC
Active
Other names
Advantage Dental Oral Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON EDMONDSON (MANAGER, LICENSING AND CREDENTIALIN)
(629) 999-5014
Entity
Organization
Contact information
Practice address
300 TATONE, BOARDMAN, OR 97818
(541) 945-4008
(541) 516-4041
Mailing address
PO BOX 11470, EUGENE, OR 97440-3670
(541) 945-4008
(541) 516-4041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500768152
—
OR
Enumeration date
07/09/2019
Last updated
10/25/2021
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