Centennial Family Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CENTENNIAL FAMILY DENTAL PC

Practice address

1290 W Centennial Blvd
Springfield, OR 97477-3566

Phone

(541) 741-0602

Fax

(541) 741-0615

NPI assigned

Aug 2, 2024

Organization subpart

No

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

Authorized official

Name

Jody Lynn Gregersen, CDA, EFDA

Title

Office Manager

Phone

(541) 741-0602

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Anthony James Elford, DDS

  • General Practice Dentistry
  • Eugene, OR
  • NPI 1114924271
  NPD (past)
• John W Larson, DMD

  • General Practice Dentistry
  • Springfield, OR
  • NPI 1427125467
  NPD (past)

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1124858477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 W CENTENNIAL BLVD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773566",
            "telephone_number": "541-741-0602",
            "fax_number": "541-741-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 W CENTENNIAL BLVD",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974773566",
            "telephone_number": "541-741-0602",
            "fax_number": "541-741-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL FAMILY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "GREGERSEN",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-741-0602",
        "authorized_official_credential": "CDA, EFDA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorna Sara Castleton-Carman
• Mark Cater, RPH
• Gerald Lee Cates, O.D.
• Heidi A. Caudle, B.A.
• Peter Galen Cavagnaro
• Lori Lee Chaffin-Britt, MSW
• Wadih Chakkour, MD
• Craig E Chamberlain, MD
• Kristen Chamberlain
• Rick Chamberlain, M.A.

• 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 Aug 2, 2024; 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.