NPIMap

Organization Active NPI

Lane Community College Dental Clinic

  • Public Health Dentistry
  • Eugene, OR
National Provider Identifier
1033539663
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
License
D5275 Issued in OR
Legal business name
LANE COMMUNITY COLLEGE DENTAL CLINIC
Practice address
2460 Willamette St
Eugene, OR 97405-3169
Phone
(541) 463-5206
Fax
(541) 463-4178
NPI assigned
Apr 22, 2014
Organization subpart
Yes
Parent organization
LANE COMMUNITY COLLEGEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sheryl Berman, PH.D
Title
Dean of Health Professions, LCC
Phone
(541) 463-5618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223D0001X D5275 OR Primary

Addresses

Primary practice location

2460 Willamette St
Eugene, OR 97405-3169

Mailing address

4000 E 30TH Ave
Division of Health Professions, Building 30
Eugene, OR 97405-0640
Phone (541) 463-5618

National Provider Directory

National Provider Directory
Tax ID family
Lane Community College2 organizations share this tax ID, including this one
Part of
Lane Community College

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4000 E 30th Ave
Bldg 30
Eugene, OR 97405

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1033539663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 E 30TH AVE",
            "address_2": "DIVISION OF HEALTH PROFESSIONS, BUILDING 30",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974050640",
            "telephone_number": "541-463-5618",
            "fax_number": "541-463-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 WILLAMETTE ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974053169",
            "telephone_number": "541-463-5206",
            "fax_number": "541-463-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANE COMMUNITY COLLEGE DENTAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LANE COMMUNITY COLLEGE",
        "enumeration_date": "2014-04-22",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "BERMAN",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_title_or_position": "DEAN OF HEALTH PROFESSIONS, LCC",
        "authorized_official_telephone_number": "541-463-5618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "OR",
            "license": "D5275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.