Provider Demographics
NPI:1588744809
Name:DRYDEN, MICHAEL THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:DRYDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GOODPASTURE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1751
Mailing Address - Country:US
Mailing Address - Phone:541-484-0470
Mailing Address - Fax:541-484-1552
Practice Address - Street 1:750 GOODPASTURE ISLAND RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1751
Practice Address - Country:US
Practice Address - Phone:541-484-0470
Practice Address - Fax:541-484-1552
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD80441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics