Provider Demographics
NPI:1619780343
Name:SMILECARE OF OREGON, LLC
Entity type:Organization
Organization Name:SMILECARE OF OREGON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THALIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:OHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-375-2206
Mailing Address - Street 1:4185 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5503
Mailing Address - Country:US
Mailing Address - Phone:503-375-2206
Mailing Address - Fax:503-375-8410
Practice Address - Street 1:4185 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5503
Practice Address - Country:US
Practice Address - Phone:503-375-2206
Practice Address - Fax:503-375-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental