Eastern Oregon Dental Clinic LLC

NPI #1609043157 in Ontario, Oregon

Provider Information

NPI Number: 1609043157
Entity Type: Organization
Organization Name: Eastern Oregon Dental Clinic LLC
Primary Specialty: Dentist
Enumeration Date: May 14, 2008
Last Updated: May 14, 2008

Practice Location

Address: 475 SW 12TH ST
City: Ontario
State: Oregon
ZIP Code: 97914-3201
Phone: (541) 881-1794

Authorized Official

Name: DR. ERIC N DAHLE, DMD
Title: MEMBER
Phone: (541) 881-1794

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary
Dentist - Endodontics — Endodontics	1223E0200X
Dentist - General Practice — General Practice	1223G0001X
Dentist - Periodontics — Periodontics	1223P0300X
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	1223S0112X

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