Mid Valley Dental of Bridgeport

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MID VALLEY DENTAL OF BRIDGEPORT

Practice address

7110 SW Hazel Fern Road
Suite 240
Tigard, OR 97224

Phone

(503) 431-3200

Fax

(503) 431-3210

NPI assigned

Nov 19, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Geoffrey Berg, DMD

Title

Owner/Dentist

Phone

(541) 928-2301

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1174348759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 SW WILLETTA ST",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "97321",
            "telephone_number": "541-928-2301",
            "fax_number": "541-928-8493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7110 SW HAZEL FERN ROAD",
            "address_2": "SUITE 240",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "97224",
            "telephone_number": "503-431-3200",
            "fax_number": "503-431-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID VALLEY DENTAL OF BRIDGEPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "541-928-2301",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Nguyen
• Marcia Michaels
• Viviana Isabella Michaud
• Michelle Stobbe
• Chelsea Maryn Michielsen, DNP, FNP
• Marisela Miguel-Gomez
• Emma Rose Miksch
• Shelby Bassett Milam, LPC
• Dock Deomus Miles IV
• Heidi Lynn Miles, THW

• General Practice Dentistry in Tigard, OR
• Providers in Tigard, 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 Nov 19, 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.