Active NPI
Shawn A Eckstrom, DDS
- General Practice Dentistry
- Eugene, OR
National Provider Identifier
1154304020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D7979
- Practice address
- 51 Santa Clara Ave
Eugene, OR 97404-2077 - Phone
- (541) 686-4567
- Fax
- (541) 228-3230
- NPI assigned
- Nov 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D7979 | OR | Primary |
Addresses
Primary practice location
51 Santa Clara Ave
Eugene, OR 97404-2077
Mailing address
51 Santa Clara Ave
Eugene, OR 97404-2077
Phone (541) 686-4567
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 229349 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7979 | OR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475798400000",
"number": "1154304020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 SANTA CLARA AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "974042077",
"telephone_number": "541-686-4567",
"fax_number": "541-228-3230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 SANTA CLARA AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "974042077",
"telephone_number": "541-686-4567",
"fax_number": "541-228-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECKSTROM",
"first_name": "SHAWN",
"middle_name": "A",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-23",
"last_updated": "2016-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D7979",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "229349",
"state": "OR"
}
],
"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 Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.