NPIMap

Individual provider Active NPI

David Eldredge, DDS

  • General Practice Dentistry
  • Corvallis, OR
National Provider Identifier
1396272811
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10373569 Issued in UT
Practice address
2500 NW Century Dr
Corvallis, OR 97330-3498
Phone
(541) 754-0600
Fax
(541) 758-4282
NPI assigned
May 15, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 10373569 UT Primary

Addresses

Primary practice location

2500 NW Century Dr
Corvallis, OR 97330-3498

Mailing address

2500 NW Century Dr
Corvallis, OR 97330-3498
Phone (541) 750-0600

Other practice location 1

1955 S 1300 E Ste L2
Salt Lake City, UT 84105-3675
Phone (801) 486-9649

Other practice location 2

7478 S Campus View Dr Ste 202
West Jordan, UT 84084-1969
Phone (801) 280-6911

Other practice location 3

1955 S 1300 E Ste L2
Salt Lake City, UT 84105-3675
Phone (801) 486-9649

Other identifiers 1

IdentifierTypeStateIssuer
D10798OtherOROREGON DENTAL LICENSE

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
10373569UTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Curtis M. Clark D.M.D., P.C. General Practice PastSince Dec 15, 2019 Accepting new patients
Jordan Landing Dental Management Past Accepting new patients
Sugar House Dental Management LLC General Practice Past Accepting new patients
Oregon Eye Consultants LLC PastSince Dec 15, 2019 Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396272811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NW CENTURY DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303498",
            "telephone_number": "541-750-0600",
            "fax_number": "541-758-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NW CENTURY DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303498",
            "telephone_number": "541-754-0600",
            "fax_number": "541-758-4282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1955 S 1300 E Ste L2",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841053675",
            "country_code": "US",
            "telephone_number": "801-486-9649",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7478 S Campus View Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "West Jordan",
            "state": "UT",
            "postal_code": "840841969",
            "country_code": "US",
            "telephone_number": "801-280-6911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1955 S 1300 E Ste L2",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841053675",
            "country_code": "US",
            "telephone_number": "801-486-9649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELDREDGE",
        "first_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "10373569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON DENTAL LICENSE",
            "identifier": "D10798",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 21, 2022; 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.