Provider Demographics
NPI:1730243379
Name:CASCADE DERMATOLOGY AND AESTHETICS
Entity type:Organization
Organization Name:CASCADE DERMATOLOGY AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-485-7546
Mailing Address - Street 1:PO BOX 5679
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-485-7546
Mailing Address - Fax:541-345-5254
Practice Address - Street 1:4765 VILLAGE PLAZA LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-485-7546
Practice Address - Fax:541-345-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR12879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1316911274OtherNPI-GREGORY C RICHTERICH
OR1063511087OtherNPI-AMANDA CHRISTENSEN PA
OR1912972175OtherNPI-KRIS MILLER, PA-C