NPIMap

Organization Active NPI

Acorn Dentistry for Kids - West Salem, LLC

  • Pediatric Dentistry
  • Salem, OR
National Provider Identifier
1043869191
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ACORN DENTISTRY FOR KIDS - WEST SALEM, LLC
Practice address
1049 Edgewater St NW
Salem, OR 97304-4046
Phone
(503) 874-4560
Fax
(503) 874-4562
NPI assigned
Sep 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Authorized official

Name
Timothy Richardson, DDS
Title
Owner
Phone
(503) 874-4560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1049 Edgewater St NW
Salem, OR 97304-4046

Mailing address

204 N 1St St Ste E
Silverton, OR 97381-1635
Phone (503) 874-4560

Other names 1

  • Acorn Dentistry for Kids - West Salem Doing business as

National Provider Directory

National Provider Directory

Locations

204 N 1st St
Ste E
Silverton, OR 97381

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568073600000",
    "number": "1043869191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 N 1ST ST STE E",
            "city": "SILVERTON",
            "state": "OR",
            "postal_code": "973811635",
            "telephone_number": "503-874-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 EDGEWATER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044046",
            "telephone_number": "503-874-4560",
            "fax_number": "503-874-4562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACORN DENTISTRY FOR KIDS - WEST SALEM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-874-4560",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acorn Dentistry for Kids - West Salem",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.