NPIMap

Organization Active NPI

Glen S Gerdes DMD PC

  • Endodontics
  • Corvallis, OR
National Provider Identifier
1295951929
Registry record updated Jun 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
D6324 Issued in OR
Legal business name
GLEN S GERDES DMD PC
Practice address
1811 NW Kings Blvd
Corvallis, OR 97330-1907
Phone
(541) 758-0888
Fax
(541) 754-6628
NPI assigned
Apr 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2008

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

Authorized official

Name
Dr. Glen S Gerdes, D.M.D, P.CNPI 1245241702
Title
Owner
Phone
(541) 758-0888

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
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X D6324 OR Primary

Addresses

Primary practice location

1811 NW Kings Blvd
Corvallis, OR 97330-1907

Mailing address

1811 NW Kings Blvd
Corvallis, OR 97330-1907
Phone (541) 758-0888

Other names 1

  • Corvallis Endodontics Doing business as

National Provider Directory

National Provider Directory

Locations

1811 NW Kings Blvd
Corvallis, OR 97330
Phone (541) 758-0888

Practitioners & affiliated clinicians

Practitioners 2

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": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1295951929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301907",
            "telephone_number": "541-758-0888",
            "fax_number": "541-754-6628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301907",
            "telephone_number": "541-758-0888",
            "fax_number": "541-754-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN S GERDES DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "GERDES",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-758-0888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D,  P.C"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "OR",
            "license": "D6324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corvallis Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corvallis, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; 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.