| Gold Beach Family Dental Inc | |
|
94223 4th St Gold Beach OR 97444 | |
| (541) 247-7332 | |
| (541) 247-9204 |
| Full Name | Gold Beach Family Dental Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 94223 4th St, Gold Beach, Oregon |
| Authorized Official Name and Position | Thomas Wayne Westfall (PRESIDENT OWNER) |
| Authorized Official Contact | 5412477332 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gold Beach Family Dental Inc Po Box 772 Gold Beach OR 97444 Ph: (541) 247-7332 | Gold Beach Family Dental Inc 94223 4th St Gold Beach OR 97444 Ph: (541) 247-7332 |
| NPI Number | 1538266713 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 02/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538266713 | NPI | - | NPPES |
| 215277 | Other | OR | OMAP |
| IJUP6C-00 | Other | OR | OHP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4990 (Oregon) | Primary |
Family Dentistry Of Gold Beach, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 29814 Ellensburg Ave, Gold Beach, OR 97444 Phone: 541-247-8000 Fax: 541-247-8888 |