Provider Demographics
NPI:1386901734
Name:MID-VALLEY ORAL, MAXILLOFACIAL & IMPLANT SURGERY
Entity type:Organization
Organization Name:MID-VALLEY ORAL, MAXILLOFACIAL & IMPLANT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SWIDERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:503-581-0223
Mailing Address - Street 1:1565 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4345
Mailing Address - Country:US
Mailing Address - Phone:503-581-0223
Mailing Address - Fax:
Practice Address - Street 1:1565 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4345
Practice Address - Country:US
Practice Address - Phone:503-581-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery