NPIMap

Organization Active NPI

Waverly Dental LLC

  • Dentist
  • Albany, OR
National Provider Identifier
1477979516
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
WAVERLY DENTAL LLC
Practice address
721 Waverly Dr SE
Albany, OR 97322-5080
Phone
(541) 928-8434
Fax
(541) 928-2756
NPI assigned
Mar 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

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

Authorized official

Name
Shawn R Griffin
Title
Administrator
Phone
(541) 929-5227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X OR Primary

Addresses

Primary practice location

721 Waverly Dr SE
Albany, OR 97322-5080

Mailing address

721 Waverly Dr SE
Albany, OR 97322-5080
Phone (541) 928-8434

National Provider Directory

National Provider Directory

Locations

721 Waverly Dr SE
Albany, OR 97322
Phone (541) 928-8434

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394668800000",
    "number": "1477979516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 WAVERLY DR SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973225080",
            "telephone_number": "541-928-8434",
            "fax_number": "541-928-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 WAVERLY DR SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973225080",
            "telephone_number": "541-928-8434",
            "fax_number": "541-928-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-13",
        "last_updated": "2014-03-13",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-929-5227"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; 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.