Provider Demographics
NPI:1699051730
Name:DENTAL WEST ASSOCIATES PC
Entity type:Organization
Organization Name:DENTAL WEST ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALEIGH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PIOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-399-0220
Mailing Address - Street 1:2245 MISSION ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1291
Mailing Address - Country:US
Mailing Address - Phone:503-399-0220
Mailing Address - Fax:503-362-9314
Practice Address - Street 1:2245 MISSION ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1291
Practice Address - Country:US
Practice Address - Phone:503-399-0220
Practice Address - Fax:503-362-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90001223G0001X
ORD89281223G0001X
ORD96761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty