Idylwood Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4063 Issued in OR

Legal business name

IDYLWOOD DENTAL LLC

Practice address

4392 Liberty Road
Salem, OR 97302-6171

Phone

(503) 315-2500

Fax

(503) 315-7227

NPI assigned

Jun 20, 2018

Organization subpart

No

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

Authorized official

Name

Edgar Merzenich, DMD

Title

Clinical Director

Phone

(503) 315-2500

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brianna Skye Meyers, RDH, EPDH

  • Dental Hygienist
  • Salem, OR
  • NPI 1972488393
  NPD (past)
• Allen Neil Rasmussen, D.M.D.

  • General Practice Dentistry
  • Salem, OR
  • NPI 1982246369
  NPD (past)
• NA Xu, DDS

  • Dentist
  • Salem, OR
  • NPI 1588840235

  General Practice

  NPD (past)

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1437643616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3000",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973028001",
            "telephone_number": "800-544-2345",
            "fax_number": "503-315-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4392 LIBERTY ROAD",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973026171",
            "telephone_number": "503-315-2500",
            "fax_number": "503-315-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDYLWOOD DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "MERZENICH",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "503-315-2500",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "4063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerardo Ibarra Elola
• Lorena Ibarra, DMD
• Icarus Counseling Inc
• Idea Telemedicine Services LLC
• Ideal Option PLLC
• Muhammad Taimoor Iftikhar, MBBS
• Rayna Ashley Kahealani Ignacio Mac Guyer
• Igor Sitnik DMD, PC
• Rebekkah Anne Igou, CADC I
• Matthew Yoshio Iguchi, PHARM.D.

• General Practice Dentistry in Salem, OR
• Providers in Salem, 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 Jun 20, 2018; 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.