| Pediatric Dentistry Of Salem Llc | |
|
2020 Commercial St Se Salem OR 97302-5208 | |
| (503) 364-7545 | |
| (503) 540-7911 |
| Full Name | Pediatric Dentistry Of Salem Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2020 Commercial St Se, Salem, Oregon |
| Authorized Official Name and Position | Weston Willard Heringer (PARTNER) |
| Authorized Official Contact | 5033647545 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry Of Salem Llc 2020 Commercial St Se Salem OR 97302-5208 Ph: (503) 364-7545 | Pediatric Dentistry Of Salem Llc 2020 Commercial St Se Salem OR 97302-5208 Ph: (503) 364-7545 |
| NPI Number | 1184831083 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184831083 | NPI | - | NPPES |
| 087163 | Medicaid | OR | |
| 233143 | Medicaid | OR | |
| 1223PO221X | Other | OR | TAXONOMY CODE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 7703 (Oregon) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 4631 (Oregon) | Secondary |
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