Organization
NORTHWEST DENTAL ASSOCIATES -MEDFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH HART (OFFICE MANAGER)
(541) 779-3993
Entity
Organization
Contact information
Practice address
3551 E BARNETT RD, SUITE 101, MEDFORD, OR 97504-7037
(541) 779-3993
(541) 779-3382
Mailing address
3551 E BARNETT RD, SUITE 101, MEDFORD, OR 97504-7037
(541) 779-3993
(541) 779-3382
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8673
OR
1223G0001X
General Practice Dentistry
D8768
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770660912
DENTAL
OR
01
—
1962623603
DENTAL
OR
Enumeration date
11/17/2016
Last updated
11/17/2016
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