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100 E Oak St Lebanon OR 97355-4135 | |
| (541) 451-1176 | |
| (541) 451-1424 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 100 E Oak St, Lebanon, Oregon |
| Authorized Official Name and Position | Patricia Clare Shader (OFFICE MANAGER/ OWNER) |
| Authorized Official Contact | 5414511176 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 E Oak St Lebanon OR 97355-4135 Ph: (541) 451-1176 | 100 E Oak St Lebanon OR 97355-4135 Ph: (541) 451-1176 |
| NPI Number | 1356578421 |
|---|---|
| Provider Enumeration Date | 06/16/2009 |
| Last Update Date | 06/16/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356578421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D6442 (Oregon) | Primary |
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