| Marshall Street Dental Clinic | |
|
344 Ne Marshall Ave Bend OR 97701-4346 | |
| (541) 389-1704 | |
| (541) 389-1705 |
| Full Name | Marshall Street Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 344 Ne Marshall Ave, Bend, Oregon |
| Authorized Official Name and Position | Ralph Michael Shirtcliff (DENTIST/OWNER/PRESIDENT) |
| Authorized Official Contact | 5413891704 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marshall Street Dental Clinic 344 Ne Marshall Ave Bend OR 97701-4346 Ph: (541) 389-1704 | Marshall Street Dental Clinic 344 Ne Marshall Ave Bend OR 97701-4346 Ph: (541) 389-1704 |
| NPI Number | 1245417450 |
|---|---|
| Provider Enumeration Date | 01/30/2008 |
| Last Update Date | 01/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245417450 | NPI | - | NPPES |
| 180968 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-4459 (Oregon) | Primary |
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