NPIMap

Organization Active NPI

Rogue Valley Family Dentistry LLC

  • General Practice Dentistry
  • Grants Pass, OR
National Provider Identifier
1265815799
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9619 Issued in OR
Legal business name
ROGUE VALLEY FAMILY DENTISTRY LLC
Practice address
1873 Williams Hwy Ste 1a
Grants Pass, OR 97527-5843
Phone
(541) 479-5505
Fax
(541) 479-7891
NPI assigned
Jul 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Authorized official

Name
Mr. Andrew Dale Gordon
Title
Buisness Manager
Phone
(541) 269-5353

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D9619 OR Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D9399 OR
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D9604 OR

Addresses

Primary practice location

1873 Williams Hwy Ste 1a
Grants Pass, OR 97527-5843

Mailing address

1250 Thompson Rd
Coos Bay, OR 97420-2538
Phone (541) 269-5353

National Provider Directory

National Provider Directory

Locations

1873 Williams Hwy
Ste 1A
Grants Pass, OR 97527
Phone (541) 479-5505

Practitioners & affiliated clinicians

Practitioners 1

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": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1265815799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202538",
            "telephone_number": "541-269-5353",
            "fax_number": "541-266-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1873 WILLIAMS HWY STE 1A",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275843",
            "telephone_number": "541-479-5505",
            "fax_number": "541-479-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE VALLEY FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "BUISNESS MANAGER",
        "authorized_official_telephone_number": "541-269-5353",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9619",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9399",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9604",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; 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.