NPIMap

Organization Active NPI

Mid-Valley Dental Associates

  • Dentist
  • Philomath, OR
National Provider Identifier
1194176016
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D10469 Issued in OR
Legal business name
MID-VALLEY DENTAL ASSOCIATES
Practice address
2811 Main St
Philomath, OR 97370-9245
Phone
(541) 929-5227
NPI assigned
Jun 22, 2016
Last updated
Jun 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

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

Authorized official

Name
Dr. Geoffrey BergNPI 1841286655
Title
Owner
Phone
(541) 928-2301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D10469 OR Primary

Addresses

Primary practice location

2811 Main St
Philomath, OR 97370-9245

Mailing address

2811 Main St
Philomath, OR 97370-9245
Phone (541) 929-5227

National Provider Directory

National Provider Directory
Tax ID family
Mid-Valley Dental Associates LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2811 Main St
Philomath, OR 97370
Phone (541) 929-5227

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1194176016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 MAIN ST",
            "city": "PHILOMATH",
            "state": "OR",
            "postal_code": "973709245",
            "telephone_number": "541-929-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 MAIN ST",
            "city": "PHILOMATH",
            "state": "OR",
            "postal_code": "973709245",
            "telephone_number": "541-929-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-22",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-928-2301",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philomath, OR

Sources for this page

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

Verify at the official NPI Registry.