Provider Demographics
NPI:1467900241
Name:OREGON FAMILY ORTHODONTICS LLC
Entity type:Organization
Organization Name:OREGON FAMILY ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-747-2111
Mailing Address - Street 1:5250 HIGH BANKS RD STE 820
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7696
Mailing Address - Country:US
Mailing Address - Phone:541-632-8442
Mailing Address - Fax:541-537-5028
Practice Address - Street 1:4122 QUEST DRIVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-8768
Practice Address - Country:US
Practice Address - Phone:541-359-3261
Practice Address - Fax:541-537-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500689621Medicaid