Provider Demographics
NPI:1447271655
Name:OREGON ORAL AND IMPLANT SURGEONS P.C.
Entity type:Organization
Organization Name:OREGON ORAL AND IMPLANT SURGEONS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-686-9750
Mailing Address - Street 1:330 S GARDEN WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8176
Mailing Address - Country:US
Mailing Address - Phone:541-686-9750
Mailing Address - Fax:541-485-5034
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8176
Practice Address - Country:US
Practice Address - Phone:541-686-9750
Practice Address - Fax:541-485-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR062682Medicaid
ORCN7173OtherPALMETTO
0000WCMBFMedicare PIN
OR062682Medicaid