Provider Demographics
NPI:1386603116
Name:SUNSET DENTAL
Entity type:Organization
Organization Name:SUNSET DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-766-8000
Mailing Address - Street 1:5208 SW PHILOMATH BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1042
Mailing Address - Country:US
Mailing Address - Phone:541-766-8000
Mailing Address - Fax:541-766-4667
Practice Address - Street 1:5208 SW PHILOMATH BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1042
Practice Address - Country:US
Practice Address - Phone:541-766-8000
Practice Address - Fax:541-766-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty