| Mosaic Medical Prineville Dental | |
|
375 Nw Beaver St Suite 101 Prineville OR 97754-1802 | |
| (541) 447-0707 | |
| (541) 383-1883 |
| Full Name | Mosaic Medical Prineville Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 375 Nw Beaver St, Prineville, Oregon |
| Authorized Official Name and Position | Megan Haase (CEO) |
| Authorized Official Contact | 5414470707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mosaic Medical Prineville Dental 600 Sw Columbia St Suite 6210 Bend OR 97702-1099 Ph: (541) 383-3005 | Mosaic Medical Prineville Dental 375 Nw Beaver St Suite 101 Prineville OR 97754-1802 Ph: (541) 447-0707 |
| NPI Number | 1174066963 |
|---|---|
| Provider Enumeration Date | 11/28/2016 |
| Last Update Date | 02/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174066963 | NPI | - | NPPES |
| 182960 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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