Provider Demographics
NPI:1700644358
Name:DENTIST IN OREGON LLC
Entity type:Organization
Organization Name:DENTIST IN OREGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:EMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-830-6881
Mailing Address - Street 1:3555 NAVARRE AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3459
Mailing Address - Country:US
Mailing Address - Phone:803-830-6881
Mailing Address - Fax:803-520-0324
Practice Address - Street 1:3555 NAVARRE AVE STE 12
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3459
Practice Address - Country:US
Practice Address - Phone:803-830-6881
Practice Address - Fax:803-520-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty