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205 N Phoenix Rd Ste 410 Phoenix OR 97535-9104 | |
(541) 535-4142 | |
(541) 535-3415 |
Full Name | |
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Speciality | Dentist |
Location | 205 N Phoenix Rd Ste 410, Phoenix, Oregon |
Authorized Official Name and Position | Jamie White (OWNER/GENERAL DENTIST) |
Authorized Official Contact | 5415354142 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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205 N Phoenix Rd Ste 410 Phoenix OR 97535-9104 Ph: (541) 535-4142 | 205 N Phoenix Rd Ste 410 Phoenix OR 97535-9104 Ph: (541) 535-4142 |
NPI Number | 1265027304 |
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Provider Enumeration Date | 03/01/2021 |
Last Update Date | 11/02/2023 |
Medicare PECOS PAC ID | 0446690010 |
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Medicare Enrollment ID | O20240430000811 |
Identifier | Type | State | Issuer |
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1265027304 | NPI | - | NPPES |
1437230521 | Other | OR | NPI |