| Dental Vision Pc | |
|
934 Ne 8th St Grants Pass OR 97526-1641 | |
| (541) 471-7062 | |
| (541) 471-8539 |
| Full Name | Dental Vision Pc |
|---|---|
| Speciality | Dentist |
| Location | 934 Ne 8th St, Grants Pass, Oregon |
| Authorized Official Name and Position | Igor Shishkin (DOCTOR/PRESIDENT) |
| Authorized Official Contact | 5414717062 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Vision Pc 934 Ne 8th St Grants Pass OR 97526-1641 Ph: (541) 471-7062 | Dental Vision Pc 934 Ne 8th St Grants Pass OR 97526-1641 Ph: (541) 471-7062 |
| NPI Number | 1376581587 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376581587 | NPI | - | NPPES |
| 122676 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D6927 (Oregon) | Primary |
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