MOSAIC MEDICAL DENTAL NPI 1659888279

NPI Information

NPI: 1659888279
Provider Name: MOSAIC MEDICAL DENTAL

Doing Business As: MOSAIC MEDICAL BEND DENTAL

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
2084 NE PROFESSIONAL CT
BEND, OR
ZIP 97701
Phone: (541) 383-3005
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MOSAIC MEDICAL DENTAL is a federally qualified health center (fqhc) clinic center in Bend, OR. MOSAIC MEDICAL DENTAL NPI is 1659888279. The provider is registered as an organization entity type.
The provider Is Doing Business As Mosaic Medical Bend Dental.

The provider's business location address is:

2084 NE PROFESSIONAL CT
BEND, OR
ZIP 97701-077
Phone: (541) 383-3005
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) 383-3005.

The enumeration date for this NPI number is 1/4/2018 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
1	261QD0000X	Clinic/Center	Dental			No
2	261QF0400X	Clinic/Center	Federally 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
1	182960	MEDICAID	OREGON

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: 4/28/2024

NPI Synchronization or Removal

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