CRISDENTAL MOBILE, LLC (NPI# 1043651896) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043651896 |
| Entity Type | Organization |
| Organization Name | CRISDENTAL MOBILE, LLC |
| Practice Address |
2530 Nw Medical Park Dr Roseburg OR 97471-5510 |
| Mailing Address |
3019 Nw Stewart Pkwy Ste 304, Box 249 Roseburg OR 97471-1602 |
| Practice Telephone | 5416736511 |
| Practice Fax Number | 5416722757 |
| Mailing Telephone | 5416722747 |
| Mailing Fax Number | 5416722757 |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2013-07-09 |
| Authorized Official Name | DR. MICHAEL JAMES BRATLAND (OWNER) |
| Authorized Official Telephone | 5416722747 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | CRISDENTAL PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | CRISDENTAL MOBILE, LLC | 2530 Nw Medical Park Drive, Roseburg, OR 97471 |
| Street Address |
2530 NW MEDICAL PARK DR |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-5510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750492054 | Bruce Edward Parker | Dentist | 2530 Nw Medical Park Dr, Roseburg, OR 97470-5510 | 2006-08-31 |
| 1083215859 | Seth Mitchell | Dentist | 2530 Nw Medical Park Dr, Roseburg, OR 97471-5510 | 2020-11-06 |
| 1689911927 | Chalene Dawn Carson | Dental Hygienist | 2530 Nw Medical Park Dr, Roseburg, OR 97471-5510 | 2013-01-07 |
| 1346538469 | American Dental L.l.c | Clinic/Center | 2530 Nw Medical Park Dr, Roseburg, OR 97471-5510 | 2011-07-11 |
| 1376672105 | Thomas G Gauthier | Dentist | 2530 Nw Medical Park Dr, Roseburg, OR 97471-5510 | 2007-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992355077 | Karla Lois Preston Wilfong | Dental Hygienist | 1600 Garden Valley Blvd, Roseburg, OR 97471-8700 | 2019-09-19 |
| 1609248392 | Lindsay Bateman | Dental Hygienist | 8150 N Umpqua Hwy, Roseburg, OR 97470-9421 | 2015-10-21 |
| 1083085864 | Cheryl Briggs | Dental Hygienist | 4776 Flournoy Valley Rd, Roseburg, OR 97471-9787 | 2015-10-19 |
| 1184955973 | Christina Olsson | Dental Hygienist | 696 Ne Winchester St, Roseburg, OR 97470-3260 | 2010-01-19 |
| 1659516482 | Sheila Rae Braack | Dental Hygienist | 2934 Oakridge Ave, Roseburg, OR 97471-2269 | 2008-12-08 |
| 1023050044 | Carol A. Poe | Dental Hygienist | 1050 Echo Dr, Roseburg, OR 97470-8478 | 2006-06-12 |
| 1881219087 | Karri Deeann Zimmerman | Dental Hygienist | 1313 W Harvard Ave, Roseburg, OR 97471-2838 | 2020-06-12 |
| 1295247666 | Teresa Dove | Dental Hygienist | 150 Ne Kenneth Ford Dr, Roseburg, OR 97470-1042 | 2017-10-25 |
| 1568980407 | Rachel Sutton | Dental Hygienist | 2700 Stewart Parkway, Roseburg, OR 97471 | 2017-08-30 |
| 1932657731 | Wendy Dougherty | Dental Hygienist | 2700 Nw Stewart Pkwy, Roseburg, OR 97471-1281 | 2016-09-21 |
| Find all providers in ROSEBURG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.