Kenneth G Mize, DMDPC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5811 Issued in OR

Practice address

411 W Main St
Sheridan, OR 97378-1117

Phone

(503) 843-4433

Fax

(503) 843-4434

NPI assigned

Jun 30, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 16, 2015 through Jul 16, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Kenneth G Mize Dmdpc

  • Dentist
  • Sheridan, OR
  • NPI 1801918255
  NPD (past) Authorized official

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255338638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W MAIN ST",
            "address_2": "P.O. BOX 100",
            "city": "SHERIDAN",
            "state": "OR",
            "postal_code": "973781117",
            "telephone_number": "503-843-4433",
            "fax_number": "503-843-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W MAIN ST",
            "city": "SHERIDAN",
            "state": "OR",
            "postal_code": "973781117",
            "telephone_number": "503-843-4433",
            "fax_number": "503-843-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZE",
        "first_name": "KENNETH",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DMDPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D5811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Jihee Kim, DDS
• Marie Louise Long, MD
• Amanda Mary Mehlhoff, FNP
• Kelly Lynn Menne
• Traci J Millsap, RN, BSN, IBCLC
• James Patrick Molloy III, M.D.
• Northwest Medical Foundation of Tillamook (Adventist Health Medical Office - Sheridan)
• Andrea L Nutt, FNP
• Monica Adriana Ortega, LMT
• Pacific Rehabilitation & Sports Medicine Inc

• General Practice Dentistry in Sheridan, OR
• Providers in Sheridan, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.