NPIMap

Organization Active NPI

Advantage Dental Group, PC

Doing business as Advantage Dental Oral Health Center

  • General Practice Dentistry
  • Bandon, OR
National Provider Identifier
1447812813
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ADVANTAGE DENTAL GROUP, PC
Doing business as
Advantage Dental Oral Health Center
Practice address
1275 Oregon Ave SE
Bandon, OR 97411-9102
Phone
(541) 551-4022
Fax
(541) 516-4058
NPI assigned
Jul 5, 2019
Last updated
Oct 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Authorized official

Name
Sharon Edmondson
Title
Manger, Licensing & Credentialing
Phone
(629) 999-5014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

1275 Oregon Ave SE
Bandon, OR 97411-9102

Mailing address

PO Box 11470
Eugene, OR 97440-3670
Phone (888) 468-0022

Other identifiers 1

IdentifierTypeStateIssuer
500694195MedicaidOR

Other names 1

  • Advantage Dental Oral Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Advantage Dental Group PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1275 Oregon Ave SE
Bandon, OR 97411
Phone (541) 347-4321

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1562284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1447812813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11470",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974403670",
            "telephone_number": "888-468-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 OREGON AVE SE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119102",
            "telephone_number": "541-551-4022",
            "fax_number": "541-516-4058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-05",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "MANGER, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "629-999-5014"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500694195",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advantage Dental Oral Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bandon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.