NPI 1750767661 · live from the CMS NPI Registry
Applegate Valley Dental INC
Dentist, General Practice in Jacksonville, OR. National Provider Identifier 1750767661, active.
NPI record
| NPI | 1750767661 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 181 Upper Applegate Rd, Suite 20, Jacksonville, OR 97530 |
| Practice phone | 541-899-7824 |
| Enumerated | August 3, 2015 |
| Last updated | August 3, 2015 |
| Authorized official | Michael Boldt, Part Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | D6349 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.