NPIMap

Organization Active NPI

James H. Tyack DMD PC

Doing business as Tyack Dental Group

  • General Practice Dentistry
  • Clatskanie, OR
National Provider Identifier
1578587192
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D5226 Issued in OR
Legal business name
JAMES H. TYACK DMD PC
Doing business as
Tyack Dental Group
Practice address
400 SW Bel Air Dr
Clatskanie, OR 97016
Phone
(503) 728-2114
NPI assigned
Jul 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James Hal Tyack, DMDNPI 1699799973
Title
President
Phone
(503) 728-2114

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D5226 OR Primary

Addresses

Primary practice location

400 SW Bel Air Dr
Clatskanie, OR 97016

Mailing address

PO Box 749
Clatskanie, OR 97016-0749
Phone (503) 728-2114

Other identifiers 2

IdentifierTypeStateIssuer
199372MedicaidOR
5043146MedicaidWA

Other names 1

  • Tyack Dental Group Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578587192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749",
            "city": "CLATSKANIE",
            "state": "OR",
            "postal_code": "970160749",
            "telephone_number": "503-728-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SW BEL AIR DR",
            "city": "CLATSKANIE",
            "state": "OR",
            "postal_code": "97016",
            "telephone_number": "503-728-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES H. TYACK DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TYACK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "HAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-728-2114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D5226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199372",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5043146",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tyack Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clatskanie, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.