NPIMap

Organization Active NPI

A Children's Dentist

  • Pediatric Dentistry
  • Battle Ground, WA
National Provider Identifier
1679728711
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DE00010670 Issued in WA
Legal business name
A CHILDREN'S DENTIST
Practice address
1215 SW Scotton Way Ste 130
Battle Ground, WA 98604-2700
Phone
(360) 666-0530
Fax
(360) 666-9144
NPI assigned
Nov 17, 2008
Last updated
Feb 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Authorized official

Name
Dr. Conway Jensen, DDSNPI 1457471773
Title
Owner
Phone
(360) 666-0530

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 Dentistry 1223P0221X DE00010670 WA Primary

Addresses

Primary practice location

1215 SW Scotton Way Ste 130
Battle Ground, WA 98604-2700

Mailing address

1215 SW Scotton Way Ste 130
Battle Ground, WA 98604-2700
Phone (360) 666-0530

National Provider Directory

National Provider Directory

Locations

1215 SW Scotton Way
#130
Battle Ground, WA 98604
Phone (360) 666-0530

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": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1679728711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SW SCOTTON WAY STE 130",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986042700",
            "telephone_number": "360-666-0530",
            "fax_number": "360-666-9144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 SW SCOTTON WAY STE 130",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986042700",
            "telephone_number": "360-666-0530",
            "fax_number": "360-666-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A CHILDREN'S DENTIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "CONWAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-666-0530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE00010670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Battle Ground, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.