OrganizationActive
Advantage Harbor Qalicb, LLC
NPI 1316368608 · General Practice Dentistry · Redmond, OR
Provider details
- NPI number
- 1316368608
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Jeanne Dysert, Exec Vp of Operations(541) 504-3900
- License
- D4459 (OR)
Specialties & taxonomies
Dental Providers
Practice location
442 Sw Umatilla Ave Ste 200
Redmond, OR 97756-7039
Phone: (541) 504-3900
Approximate (ZIP-level) locationGet directions
Mailing address
442 Sw Umatilla Ave Ste 200
Redmond, OR 97756-7039
Registry dates
- Enumerated
- 2014-01-03
- Last updated
- 2014-01-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.