South Umpqua Family Dental
Organization Active NPI General Practice Dentistry · Riddle, OR
NPI 1033349816 · NPPES record last updated Jul 15, 2009
Key facts
- NPI
- 1033349816
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D9281 (OR)
- Legal business name
- SOUTH UMPQUA FAMILY DENTAL
- Practice address
- 150 Main Street
Riddle, OR 97469 - Phone
- (541) 874-3126
- Fax
- (541) 874-3259
- NPI assigned
- Jul 15, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Eric Cornelius, DDS
- Title
- Managing Member
- Phone
- (541) 874-3126
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | D9281 | OR | Yes |
Addresses
Primary practice location
150 Main Street
Riddle, OR 97469
Mailing address
150 Main Street
Riddle, OR 97469
Phone (541) 874-3126
Other providers in Riddle, OR
- Kathryn Sue McGinnis
- Blake Rice
- Riddle Dental Care Associates
- Riddle Dental Care Associates
- Riddle Pharmacy LLC
- South Umpqua Family Dental PC
All providers in Riddle, OR · General Practice Dentistry in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.