Active NPI
Cody Merril Bywaters, LICENSED DENTURIST
- Denturist
- Lake Oswego, OR
National Provider Identifier
1407100233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- DTDO10126042
- Practice address
- 3900 Douglas Way
Lake Oswego, OR 97035-3446 - Phone
- (503) 635-8060
- Fax
- (503) 305-8679
- NPI assigned
- Oct 31, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | DTDO10126042 | OR | Primary |
Addresses
Primary practice location
3900 Douglas Way
Lake Oswego, OR 97035-3446
Mailing address
3900 Douglas Way
Lake Oswego, OR 97035-3446
Phone (503) 635-8060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DTDO 10126042 | Other | OR | DENTURIST HEALTH LICENSE STATE OF OREGON |
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
| License | State | Type | Specialty |
|---|---|---|---|
| DTDO10126042 | OR | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351641600000",
"number": "1407100233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 DOUGLAS WAY",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970353446",
"telephone_number": "503-635-8060",
"fax_number": "503-305-8679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 DOUGLAS WAY",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970353446",
"telephone_number": "503-635-8060",
"fax_number": "503-305-8679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BYWATERS",
"first_name": "CODY",
"middle_name": "MERRIL",
"name_prefix": "Mr.",
"credential": "LICENSED DENTURIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-31",
"last_updated": "2012-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "OR",
"license": "DTDO10126042",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTURIST HEALTH LICENSE STATE OF OREGON",
"identifier": "DTDO 10126042",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.