| Family Dental Group | |
|
4734 River Rd N Keizer OR 97303-4536 | |
| (503) 463-4663 | |
| (503) 463-4666 |
| Full Name | Family Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4734 River Rd N, Keizer, Oregon |
| Authorized Official Name and Position | Timothy R. Harbolt (PRESIDENT) |
| Authorized Official Contact | 5035516349 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Group 4734 River Rd N Keizer OR 97303-4536 Ph: (503) 463-4663 | Family Dental Group 4734 River Rd N Keizer OR 97303-4536 Ph: (503) 463-4663 |
| NPI Number | 1114924933 |
|---|---|
| Provider Enumeration Date | 07/07/2005 |
| Last Update Date | 09/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114924933 | NPI | - | NPPES |
| D6816 | Other | OR | STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D6816 (Oregon) | Primary |
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