Active NPI
Riddle Dental Care Associates
- General Practice Dentistry
- Riddle, OR
National Provider Identifier
1679684740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6774
- Legal business name
- RIDDLE DENTAL CARE ASSOCIATES
- Practice address
- 150 S Main St
Riddle, OR 97469 - Phone
- (541) 874-3126
- Fax
- (541) 874-3259
- NPI assigned
- Aug 31, 2006
- Last updated
- Feb 25, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Gloria J Mann
- Title
- Accounts Manager Sec Treas
- Phone
- (541) 874-3126
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6774 | OR | Primary |
Addresses
Primary practice location
150 S Main St
Riddle, OR 97469
Mailing address
PO Box 107
150 S Main
Riddle, OR 97469
Phone (541) 863-5524
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 074612 | Medicaid | OR | |
| 6774 | Other | OR | DENTAL |
Other names 1
- Jeffrey D Baxter
National Provider Directory
National Provider Directory- Tax ID family
- Jeffrey D Baxter
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Dentistry
- Riddle, OR
- NPI 1588833883
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1203897600000",
"number": "1679684740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 107",
"address_2": "150 S MAIN",
"city": "RIDDLE",
"state": "OR",
"postal_code": "97469",
"telephone_number": "541-863-5524",
"fax_number": "541-874-3259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S MAIN ST",
"city": "RIDDLE",
"state": "OR",
"postal_code": "97469",
"telephone_number": "541-874-3126",
"fax_number": "541-874-3259"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RIDDLE DENTAL CARE ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-31",
"last_updated": "2008-02-25",
"status": "A",
"authorized_official_last_name": "MANN",
"authorized_official_first_name": "GLORIA",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "ACCOUNTS MANAGER SEC TREAS",
"authorized_official_telephone_number": "541-874-3126",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "6774",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "074612",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL",
"identifier": "6774",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Jeffrey D Baxter",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Riddle, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.