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1285 Wallace Rd Nw Salem OR 97304-3007 | |
| (503) 391-9016 | |
| (503) 391-2953 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1285 Wallace Rd Nw, Salem, Oregon |
| Authorized Official Name and Position | Michelle Renee Aldrich (MEMBER) |
| Authorized Official Contact | 5033919016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1285 Wallace Rd Nw Salem OR 97304-3007 Ph: (503) 391-9016 | 1285 Wallace Rd Nw Salem OR 97304-3007 Ph: (503) 391-9016 |
| NPI Number | 1831325489 |
|---|---|
| Provider Enumeration Date | 06/09/2009 |
| Last Update Date | 06/09/2009 |
| Medicare PECOS PAC ID | 8628394137 |
|---|---|
| Medicare Enrollment ID | O20150227000974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831325489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D9153 (Oregon) | Primary |
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