Dental Vision PC
Organization Active NPI Dentist · Grants Pass, OR
NPI 1376581587 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1376581587
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- D6927 (OR)
- Legal business name
- DENTAL VISION PC
- Practice address
- 934 NE 8TH St
Grants Pass, OR 97526-1641 - Phone
- (541) 471-7062
- Fax
- (541) 471-8539
- NPI assigned
- Jun 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Igor Shishkin, DDS
- Title
- Doctor/President
- Phone
- (541) 471-7062
Practitioners 3
-
Rebecca Lee Forshaw, DMD
-
Igor Shishkin, DDS
National Provider Directory
Locations
934 NE 8th St
Grants Pass, OR 97526
Phone (541) 471-7062
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | D6927 | OR | Yes |
Addresses
Primary practice location
934 NE 8TH St
Grants Pass, OR 97526-1641
Mailing address
934 NE 8TH St
Grants Pass, OR 97526-1641
Phone (541) 471-7062
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122676 | Medicaid | OR |
Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.