NPIMap

Organization Active NPI

Advantage Dental Associates of Crook County, LLC

  • General Practice Dentistry
  • Prineville, OR
National Provider Identifier
1649573585
Registry record updated Dec 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ADVANTAGE DENTAL ASSOCIATES OF CROOK COUNTY, LLC
Practice address
257 NE 2ND St
Prineville, OR 97754-1910
Phone
(541) 447-5838
Fax
(541) 447-5883
NPI assigned
Dec 15, 2010
Last updated
Dec 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2010

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

Authorized official

Name
Dr. R. Mike Shirtcliff, DMD
Title
Authorized Representative
Phone
(541) 447-5838

Specialties & licenses 1

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

Addresses

Primary practice location

257 NE 2ND St
Prineville, OR 97754-1910

Mailing address

257 NE 2ND St
Prineville, OR 97754-1910
Phone (541) 447-5838

National Provider Directory

National Provider Directory

Locations

257 NE 2nd St
Prineville, OR 97754
Phone (541) 447-5838

Practitioners & affiliated clinicians

Practitioners 5

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": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292371200000",
    "number": "1649573585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 NE 2ND ST",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541910",
            "telephone_number": "541-447-5838",
            "fax_number": "541-447-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 NE 2ND ST",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541910",
            "telephone_number": "541-447-5838",
            "fax_number": "541-447-5883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL ASSOCIATES OF CROOK COUNTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2010-12-15",
        "status": "A",
        "authorized_official_last_name": "SHIRTCLIFF",
        "authorized_official_first_name": "R. MIKE",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "541-447-5838",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prineville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; 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.