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1275 Oregon Ave Se Bandon OR 97411-9102 | |
(541) 551-4022 | |
(541) 516-4058 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 1275 Oregon Ave Se, Bandon, Oregon |
Authorized Official Name and Position | Sharon Edmondson (MANGER, LICENSING & CREDENTIALING) |
Authorized Official Contact | 6299995014 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 11470 Eugene OR 97440-3670 Ph: (888) 468-0022 | 1275 Oregon Ave Se Bandon OR 97411-9102 Ph: (541) 551-4022 |
NPI Number | 1447812813 |
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Provider Enumeration Date | 07/05/2019 |
Last Update Date | 10/25/2021 |
Identifier | Type | State | Issuer |
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1447812813 | NPI | - | NPPES |
500694195 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |