| Fourth Street Family Dental, Pc | |
|
530 Se 4th St Hermiston OR 97838-2416 | |
| (541) 567-1693 | |
| (541) 567-2840 |
| Full Name | Fourth Street Family Dental, Pc |
|---|---|
| Speciality | Dentist |
| Location | 530 Se 4th St, Hermiston, Oregon |
| Authorized Official Name and Position | Gregory B Jones (OWNER) |
| Authorized Official Contact | 5415671693 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fourth Street Family Dental, Pc 530 Se 4th Street Hermiston OR 97838 Ph: (541) 567-1693 | Fourth Street Family Dental, Pc 530 Se 4th St Hermiston OR 97838-2416 Ph: (541) 567-1693 |
| NPI Number | 1447672142 |
|---|---|
| Provider Enumeration Date | 01/15/2014 |
| Last Update Date | 01/15/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447672142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D6986 (Oregon) | Primary |
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