| Mirror Pond Dental, Llc | |
|
102 Nw Newport Ave Bend OR 97703-1838 | |
| (541) 382-2256 | |
| (541) 389-5229 |
| Full Name | Mirror Pond Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 102 Nw Newport Ave, Bend, Oregon |
| Authorized Official Name and Position | Marc Nordstrom (OWNER) |
| Authorized Official Contact | 5413822256 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mirror Pond Dental, Llc 102 Nw Newport Ave Bend OR 97703-1838 Ph: (541) 382-2256 | Mirror Pond Dental, Llc 102 Nw Newport Ave Bend OR 97703-1838 Ph: (541) 382-2256 |
| NPI Number | 1225401052 |
|---|---|
| Provider Enumeration Date | 11/02/2015 |
| Last Update Date | 11/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225401052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D7335 (Oregon) | Primary |
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