Provider Demographics
NPI:1720789068
Name:ELGIN FAMILY DENTAL LLC
Entity type:Organization
Organization Name:ELGIN FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:971-275-2206
Mailing Address - Street 1:75657 UPPER DIAMOND LN
Mailing Address - Street 2:
Mailing Address - City:WALLOWA
Mailing Address - State:OR
Mailing Address - Zip Code:97885-8208
Mailing Address - Country:US
Mailing Address - Phone:971-275-2206
Mailing Address - Fax:
Practice Address - Street 1:570 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OR
Practice Address - Zip Code:97827-9726
Practice Address - Country:US
Practice Address - Phone:971-275-2206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental