Provider Demographics
NPI:1538434022
Name:SUBLIMITY DENTAL
Entity type:Organization
Organization Name:SUBLIMITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-769-5611
Mailing Address - Street 1:231 NW STARR ST
Mailing Address - Street 2:
Mailing Address - City:SUBLIMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97385-9827
Mailing Address - Country:US
Mailing Address - Phone:503-769-5611
Mailing Address - Fax:
Practice Address - Street 1:231 NW STARR ST
Practice Address - Street 2:
Practice Address - City:SUBLIMITY
Practice Address - State:OR
Practice Address - Zip Code:97385-9827
Practice Address - Country:US
Practice Address - Phone:503-769-5611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty