Centennial Family Dental PC
Dentist, General Practice in Springfield, OR. Organization (NPI-2).
NPI number1124858477
StatusActive
Last updated in NPPESAug 2, 2024
Details
- NPI
- 1124858477
- Entity type
- Organization (NPI-2)
- Legal business name
- Centennial Family Dental PC
- Organization subpart
- No
- Enumeration date
- Aug 2, 2024
- Certification date
- Aug 2, 2024
- Last updated
- Aug 2, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
1290 W Centennial BlvdSpringfield, OR 97477-3566
Phone 541-741-0602 · Fax 541-741-0615
Mailing address
1290 W Centennial BlvdSpringfield, OR 97477-3566
Phone 541-741-0602 · Fax 541-741-0615
Authorized official
Jody Lynn Gregersen
Office Manager
5417410602
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