Equity Dental Clinic, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

EQUITY DENTAL CLINIC, PC

Practice address

648 Chetco Ave
Brookings, OR 97415-8010

Phone

(541) 216-4469

Fax

(541) 216-4725

NPI assigned

Jul 31, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Mike Shirtcliff, DMD

Title

President

Phone

(541) 680-9028

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1722384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1558190033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1748",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977560518",
            "telephone_number": "541-216-4469",
            "fax_number": "541-216-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "648 CHETCO AVE",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974158010",
            "telephone_number": "541-216-4469",
            "fax_number": "541-216-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUITY DENTAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "SHIRTCLIFF",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-680-9028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Patrick Duffy, MFT
• Jeannie Duryea
• Catrina Leanne Dzambik
• Jennifer Dawn Eichlin
• Jeri Elam
• Equity Dental Clinics Brookings, LLC
• Nancy A Erb, GNP
• Breana Erickson
• Tonya Shantel Escobar, PMHNP
• Eye Center of Brookings, LLC

• Dentist in Brookings, OR
• Providers in Brookings, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.