Mirror Pond Dental, LLC

NPI #1225401052 in Bend, Oregon

Provider Information

NPI Number: 1225401052
Entity Type: Organization
Organization Name: Mirror Pond Dental, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 2, 2015
Last Updated: Nov 2, 2015

Practice Location

Address: 102 NW NEWPORT AVE
City: Bend
State: Oregon
ZIP Code: 97703-1838
Phone: (541) 382-2256

Authorized Official

Name: MARC NORDSTROM, DMD
Title: OWNER
Phone: (541) 382-2256

Specialties & Taxonomy Codes

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

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