Provider Demographics
NPI:1154768562
Name:NEIGHBORHOOD DENTISTRY
Entity type:Organization
Organization Name:NEIGHBORHOOD DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-363-8466
Mailing Address - Street 1:1109 LIBERTY CIR S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2435
Mailing Address - Country:US
Mailing Address - Phone:503-363-8466
Mailing Address - Fax:503-485-2986
Practice Address - Street 1:1109 LIBERTY CIR S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-2435
Practice Address - Country:US
Practice Address - Phone:503-363-8466
Practice Address - Fax:503-485-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8945261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006311Medicaid