Organization Name: | SCAPPOOSE DENTAL SPECIALTY CLINIC, LLC |
NPI Number: | 1275808826 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TSUNG-JU HSIEH (PRESIDENT) |
Mailing Address: | 51701 Columbia River Hwy Scappoose |
State: | OR US |
Postal Code: | 970564441 |
Phone Number: | 5039871378 |
Fax Number: | 5034675592 |
NPI Enumeration Date: | 03/15/2012 |
NPI Last Update Date: | 03/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D8383 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |