Sutherlin Dental

NPI #1043456403 in Sutherlin, Oregon

Provider Information

NPI Number: 1043456403
Entity Type: Organization
Organization Name: Sutherlin Dental
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jan 6, 2009
Last Updated: Jan 6, 2009

Practice Location

Address: 115 N STATE ST
City: Sutherlin
State: Oregon
ZIP Code: 97479-9807
Phone: (541) 459-4612

Authorized Official

Name: DR. MONTE' ERELL MONTGOMERY, D.D.S.
Title: PRESIDENT
Phone: (541) 459-4612

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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