Organization Name: | FAIRVIEW ORTHODONTICS LLC |
NPI Number: | 1184888307 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES JOSEPH JASPER (MANAGER) |
Mailing Address: | 1547 Ne Market Dr Fairview |
State: | OR US |
Postal Code: | 970243864 |
Phone Number: | 5036668000 |
Fax Number: | |
NPI Enumeration Date: | 07/16/2008 |
NPI Last Update Date: | 07/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D8879 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |