Provider Demographics
NPI:1982619342
Name:WELLNESS CENTERED DENTISTRY
Entity type:Organization
Organization Name:WELLNESS CENTERED DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-868-2008
Mailing Address - Street 1:300 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-868-2008
Mailing Address - Fax:541-868-2009
Practice Address - Street 1:300 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 290
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-868-2008
Practice Address - Fax:541-868-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty