Provider Demographics
NPI:1063411437
Name:SEA BRITE DENTAL PC
Entity type:Organization
Organization Name:SEA BRITE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-963-2741
Mailing Address - Street 1:10609 S WALTON RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97850-8488
Mailing Address - Country:US
Mailing Address - Phone:541-963-2741
Mailing Address - Fax:541-963-7439
Practice Address - Street 1:10609 S WALTON RD
Practice Address - Street 2:
Practice Address - City:ISLAND CITY
Practice Address - State:OR
Practice Address - Zip Code:97850-8488
Practice Address - Country:US
Practice Address - Phone:541-963-2741
Practice Address - Fax:541-963-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty