Basic Information
| Provider Information | |||||||||
| NPI: | 1053066894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OR SPECIALTY DENTAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CHURCH ST STE 1900 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156780759 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 CHURCH ST SE STE 102 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035811999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2022 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | EYRE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER OF ENTITY | ||||||||
| AuthorizedOfficialTelephone: | 5035806099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS0112X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery |
No ID Information.