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Crisdental Grants Pass LLC

Dentist, General Practice in Grants Pass, OR. Organization (NPI-2).

NPI number1790239697
StatusActive
Last updated in NPPESAug 9, 2016

Details

NPI
1790239697
Entity type
Organization (NPI-2)
Legal business name
Crisdental Grants Pass LLC
Organization subpart
Yes
Enumeration date
Aug 9, 2016
Last updated
Aug 9, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General PracticeD8594ORYes

Practice location

934 Ne 8th St
Grants Pass, OR 97526-1641

Phone 541-492-1687 · Fax 866-216-6527

Mailing address

Po Box 1405
Roseburg, OR 97470-0338

Phone 541-492-1687 · Fax 866-216-6527

Authorized official

Michael J Bratland
Owner
5414921687

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