| Hales Dental Practice, Pc | |
|
781 Ne 7th St B Grants Pass OR 97526-1654 | |
| (541) 474-1100 | |
| (541) 474-1103 |
| Full Name | Hales Dental Practice, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 781 Ne 7th St, Grants Pass, Oregon |
| Authorized Official Name and Position | Jim B Hales (DENTIST/OWNER) |
| Authorized Official Contact | 5414741100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hales Dental Practice, Pc 781 Ne 7th St B Grants Pass OR 97526-1654 Ph: (541) 474-1100 | Hales Dental Practice, Pc 781 Ne 7th St B Grants Pass OR 97526-1654 Ph: (541) 474-1100 |
| NPI Number | 1790229383 |
|---|---|
| Provider Enumeration Date | 12/15/2016 |
| Last Update Date | 12/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790229383 | NPI | - | NPPES |
| 6080140001 | Other | OR | MEDICARE DME PTAN |
| 040241 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D6777 (Oregon) | Primary |
| 305S00000X | Point Of Service | D6777 (Oregon) | Secondary |
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