Timothy R. Harbolt, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6816 Issued in OR

Legal business name

TIMOTHY R. HARBOLT, DMD

Doing business as

Family Dental Group

Practice address

4734 River Rd N
Keizer, OR 97303-4536

Phone

(503) 463-4663

Fax

(503) 463-4666

NPI assigned

Jul 7, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Timothy R. Harbolt, D.M.D.

Title

President

Phone

(503) 551-6349

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Dental Group Doing business as

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347235200000",
    "number": "1114924933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4734 RIVER RD N",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973034536",
            "telephone_number": "503-463-4663",
            "fax_number": "503-463-4666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4734 RIVER RD N",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973034536",
            "telephone_number": "503-463-4663",
            "fax_number": "503-463-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY R. HARBOLT, DMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-09-10",
        "status": "A",
        "authorized_official_last_name": "HARBOLT",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-551-6349",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D6816",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Keizer, OR
• Providers in Keizer, 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 Sep 10, 2012; 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.