Individual provider Active NPI

Timothy Richardson, DDS

  • Pediatric Dentistry
  • Eugene, OR
National Provider Identifier
1184855967
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
9577 Issued in OR
Practice address
4122 Quest Dr
Eugene, OR 97402-8768
Phone
(541) 844-1667
Fax
(541) 505-8463
NPI assigned
Jul 28, 2009
Last updated
Apr 12, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 9577 OR Primary

Addresses

Primary practice location

4122 Quest Dr
Eugene, OR 97402-8768

Mailing address

4122 Quest Dr
Eugene, OR 97402-8768
Phone (541) 844-1667

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

LicenseStateTypeSpecialty
9577ORMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Acorn Dentistry for Kids - Hillsboro, LLC Past Accepting new patients
Acorn Dentistry for Kids - Keizer, LLC Past Accepting new patients
Eugene Kids' Dentist, LLC Pediatric Dentistry Past Accepting new patients
Oregon Family Orthodontics LLC PastSince Dec 8, 2024 Accepting new patients
Acorn Dentistry for Kids - Corvallis, LLC Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1184855967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4122 QUEST DR",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974028768",
            "telephone_number": "541-844-1667",
            "fax_number": "541-505-8463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4122 QUEST DR",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974028768",
            "telephone_number": "541-844-1667",
            "fax_number": "541-505-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-28",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "9577",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 12, 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.