NPIMap

Organization Active NPI

Dimitrios J. Vareldzis DDS, PC

Doing business as Bull Mountain Family Dental

  • Dentist
  • Tigard, OR
National Provider Identifier
1174657217
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D6471 Issued in OR
Legal business name
DIMITRIOS J. VARELDZIS DDS, PC
Doing business as
Bull Mountain Family Dental
Practice address
15885 SW 116TH Ave
Tigard, OR 97224-2647
Phone
(503) 639-5025
Fax
(503) 684-1391
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Dimitrios John Vareldzis, DDSNPI 1538166939
Title
President
Phone
(503) 639-5025

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D6471 OR Primary

Addresses

Primary practice location

15885 SW 116TH Ave
Tigard, OR 97224-2647

Mailing address

15885 SW 116TH Ave
Tigard, OR 97224-2647
Phone (503) 639-5025

Other names 1

  • Bull Mountain Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

15885 SW 116th Ave
Tigard, OR 97224
Phone (503) 639-5025

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174657217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15885 SW 116TH AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242647",
            "telephone_number": "503-639-5025",
            "fax_number": "503-684-1391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15885 SW 116TH AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242647",
            "telephone_number": "503-639-5025",
            "fax_number": "503-684-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMITRIOS J. VARELDZIS DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VARELDZIS",
        "authorized_official_first_name": "DIMITRIOS",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-639-5025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bull Mountain Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.