NPIMap

Organization Active NPI

Applegate Valley Dental, Inc.

  • General Practice Dentistry
  • Jacksonville, OR
National Provider Identifier
1477939494
Registry record updated Jul 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D6262 Issued in OR
Legal business name
APPLEGATE VALLEY DENTAL, INC.
Practice address
181 Upper Applegate Rd
Suite 20
Jacksonville, OR 97530-9739
Phone
(541) 899-7824
Fax
(541) 899-7949
NPI assigned
Jul 31, 2015
Last updated
Jul 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2015

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

Authorized official

Name
Dr. Thomas Glenn Brooks, DMDNPI 1306974035
Title
Part Owner
Phone
(541) 855-7920

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D6262 OR Primary

Addresses

Primary practice location

181 Upper Applegate Rd
Suite 20
Jacksonville, OR 97530-9739

Mailing address

181 Upper Applegate Rd
Suite 20
Jacksonville, OR 97530-9739
Phone (541) 899-7824

National Provider Directory

National Provider Directory
Tax ID family
Applegate Valley Dental Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1438300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438300800000",
    "number": "1477939494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 UPPER APPLEGATE RD",
            "address_2": "SUITE 20",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309739",
            "telephone_number": "541-899-7824",
            "fax_number": "541-899-7949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 UPPER APPLEGATE RD",
            "address_2": "SUITE 20",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309739",
            "telephone_number": "541-899-7824",
            "fax_number": "541-899-7949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLEGATE VALLEY DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-31",
        "last_updated": "2015-07-31",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "541-855-7920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; 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.