McKenzie River Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MCKENZIE RIVER DENTAL, LLC

Practice address

244 6TH St
Springfield, OR 97477-4602

Phone

(541) 736-0044

Fax

(541) 654-4552

NPI assigned

Apr 19, 2022

Organization subpart

No

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

Authorized official

Name

Deanna Cole

Title

Practice Manager

Phone

(541) 736-0044

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1114660800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 6TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774602",
            "telephone_number": "541-736-0044",
            "fax_number": "541-654-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 6TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774602",
            "telephone_number": "541-736-0044",
            "fax_number": "541-654-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE RIVER DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "541-736-0044"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Springfield, OR
• Providers in Springfield, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.