South Umpqua Family Dental

NPI #1033349816 in Riddle, Oregon

Provider Information

NPI Number: 1033349816
Entity Type: Organization
Organization Name: South Umpqua Family Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 15, 2009
Last Updated: Jul 15, 2009

Practice Location

Address: 150 MAIN STREET
City: Riddle
State: Oregon
ZIP Code: 97469
Phone: (541) 874-3126

Authorized Official

Name: DR. ERIC CORNELIUS, DDS
Title: MANAGING MEMBER
Phone: (541) 874-3126

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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