| Uchc Denture Lab | |
|
1423 Nw Fairmount St Roseburg OR 97470-2065 | |
| (541) 672-9596 | |
| (541) 492-2060 |
| Full Name | Uchc Denture Lab |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1423 Nw Fairmount St, Roseburg, Oregon |
| Authorized Official Name and Position | KC Bolton (CEO) |
| Authorized Official Contact | 5416729596 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Uchc Denture Lab 150 Ne Kenneth Ford Dr Roseburg OR 97470-1042 Ph: (541) 672-9596 | Uchc Denture Lab 1423 Nw Fairmount St Roseburg OR 97470-2065 Ph: (541) 672-9596 |
| NPI Number | 1700502440 |
|---|---|
| Provider Enumeration Date | 10/14/2022 |
| Last Update Date | 10/14/2022 |
| Certification Date | 10/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700502440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| 122400000X | Denturist | (NU) | Secondary |
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