NPIMap

Organization Active NPI

Spinnaker Pediatric Dentistry PC

  • Pediatric Dentistry
  • Salem, OR
National Provider Identifier
1629343967
Registry record updated Mar 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SPINNAKER PEDIATRIC DENTISTRY PC
Practice address
1105 12TH St SE
Salem, OR 97302-2810
Phone
(503) 363-5865
Fax
(503) 363-8510
NPI assigned
Mar 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2012

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

Authorized official

Name
Dr. Sean A Cooper, DDSNPI 1457376782
Title
President
Phone
(503) 363-5865

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1105 12TH St SE
Salem, OR 97302-2810

Mailing address

1105 12TH St SE
Salem, OR 97302-2810
Phone (503) 363-5865

National Provider Directory

National Provider Directory

Locations

1105 12th St SE
Salem, OR 97302
Phone (503) 363-5865

Practitioners & affiliated clinicians

Practitioners 3

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": "1332201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332201600000",
    "number": "1629343967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022810",
            "telephone_number": "503-363-5865",
            "fax_number": "503-363-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022810",
            "telephone_number": "503-363-5865",
            "fax_number": "503-363-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINNAKER PEDIATRIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-20",
        "last_updated": "2012-03-20",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-363-5865",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; 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.