Active NPI
Craig Elgin, DMD, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- North Bend, OR
National Provider Identifier
1639428634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- D10379
- Practice address
- 2901 Broadway Ave
North Bend, OR 97459-2219 - Phone
- (541) 756-3181
- NPI assigned
- Sep 5, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DE 60278162 | WA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | D10379 | OR | Primary |
Addresses
Primary practice location
2901 Broadway Ave
North Bend, OR 97459-2219
Mailing address
2901 Broadway Ave
North Bend, OR 97459-2219
Phone (541) 756-3181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10379 | OR | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| DE 60278162 | WA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556496000000",
"number": "1639428634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 BROADWAY AVE",
"city": "NORTH BEND",
"state": "OR",
"postal_code": "974592219",
"telephone_number": "541-756-3181",
"fax_number": "719-576-1929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 BROADWAY AVE",
"city": "NORTH BEND",
"state": "OR",
"postal_code": "974592219",
"telephone_number": "541-756-3181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELGIN",
"first_name": "CRAIG",
"name_prefix": "Dr.",
"credential": "DMD, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-05",
"last_updated": "2019-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WA",
"license": "DE 60278162",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "OR",
"license": "D10379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.