Organization
MOSAIC MEDICAL DENTAL
Active
Parent organization
MOSAIC MEDICAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOSAIC MEDICAL
Authorized official
VANESSA LANGLEY (CREDENTIALING SPECIALIST)
(541) 383-3005
Entity
Organization
Contact information
Practice address
1250 SW VETERANS WAY, REDMOND, OR 97756-2585
(541) 923-4462
(541) 383-1883
Mailing address
600 SW COLUMBIA ST STE 6210, BEND, OR 97702-1099
(541) 383-3005
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182960
—
OR
Enumeration date
05/26/2017
Last updated
05/26/2017
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