Organization
BIRCH AVENUE DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PARK W MCCLUNG D.D.S. (PRESIDENT)
(541) 942-2471
Entity
Organization
Contact information
Practice address
1325 BIRCH AVE, COTTAGE GROVE, OR 97424-1416
(541) 942-2471
(541) 942-9318
Mailing address
1325 BIRCH AVE, COTTAGE GROVE, OR 97424-1416
(541) 942-2471
(541) 942-9318
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6947
OR
Other
Enumeration date
11/15/2006
Last updated
08/22/2020
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