Provider Demographics
NPI:1154900249
Name:OREGON ENDODONTICS
Entity type:Organization
Organization Name:OREGON ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMSON ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-261-9539
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-0127
Mailing Address - Country:US
Mailing Address - Phone:541-351-8069
Mailing Address - Fax:
Practice Address - Street 1:8815 KEYS PLACE
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367
Practice Address - Country:US
Practice Address - Phone:541-351-8069
Practice Address - Fax:541-418-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1235128745Medicaid
OR023810Medicaid