NPIMap

Organization Active NPI

Creekside Family Dental PC

Doing business as Bryan K Nakagawa DMD

  • General Practice Dentistry
  • Salem, OR
National Provider Identifier
1659408276
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7934 Issued in OR
Legal business name
CREEKSIDE FAMILY DENTAL PC
Doing business as
Bryan K Nakagawa DMD
Practice address
620 12TH St SE
Salem, OR 97301-4001
Phone
(503) 581-2454
Fax
(503) 581-1819
NPI assigned
Feb 28, 2007
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
Bryan Nakagawa, DMDNPI 1639451727
Title
President
Phone
(503) 581-2454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 7934 OR Primary

Addresses

Primary practice location

620 12TH St SE
Salem, OR 97301-4001

Mailing address

620 12TH St SE
Salem, OR 97301-4001
Phone (503) 581-2454

Other names 1

  • Bryan K Nakagawa DMD Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659408276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014001",
            "telephone_number": "503-581-2454",
            "fax_number": "503-581-1819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014001",
            "telephone_number": "503-581-2454",
            "fax_number": "503-581-1819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE FAMILY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NAKAGAWA",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-581-2454",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "7934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bryan K Nakagawa DMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 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.