MOSAIC MEDICAL DENTAL NPI 1174066963

NPI Information

  • NPI: 1174066963
  • Provider Name: MOSAIC MEDICAL DENTAL
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Doing Business As: MOSAIC MEDICAL PRINEVILLE DENTAL
  • Address: 375 NW BEAVER ST
    SUITE 101
    PRINEVILLE, OR
    ZIP 97754
  • Phone: (541) 447-0707

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NPI Details

MOSAIC MEDICAL DENTAL is a federally qualified health center (fqhc) clinic center in Prineville, OR. MOSAIC MEDICAL DENTAL NPI is 1174066963. The provider is registered as an organization entity type.
The provider Is Doing Business As Mosaic Medical Prineville Dental.

The provider's business location address is:

375 NW BEAVER ST
SUITE 101
PRINEVILLE, OR
ZIP 97754-802
Phone: (541) 447-0707
Fax: (541) 383-1883

The provider's authorized official is Megan Haase .
The authorized official title is Ceo and has the following contact phone number (541) 447-0707.

The enumeration date for this NPI number is 11/28/2016 and was last updated on 2/28/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QD0000XClinic/CenterDentalNo
2261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1182960MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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