Corvallis Dental Group Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D54041 Issued in OR

Legal business name

CORVALLIS DENTAL GROUP INC

Practice address

2318 NW Kings Blvd
Corvallis, OR 97330-3925

Phone

(541) 754-6116

Fax

(541) 753-3616

NPI assigned

Jul 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Judith A Slack

Title

Office Manager

Phone

(541) 754-6116

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689694291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2318 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303925",
            "telephone_number": "541-754-6116",
            "fax_number": "541-753-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2318 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303925",
            "telephone_number": "541-754-6116",
            "fax_number": "541-753-3616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORVALLIS DENTAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SLACK",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-754-6116"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6074",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D54041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corvallis Birth and Womens Health Center (Corvallis Birth and Wellness Center)
• Corvallis Children's Dentistry PC
• Corvallis Clinic PC (Corvallis Clinic Aumann DME only)
• Corvallis Clinic PC (Corvallis Clinic Walnut CME only)
• Corvallis Daytime Drop-in Center
• Corvallis Eye Care
• Corvallis Family Dentistry, LLC
• Corvallis Family Medicine PC
• Corvallis Gastroenterology PC
• Corvallis Homeless Shelter Coalition (Corvallis Housing First)

• General Practice Dentistry in Corvallis, OR
• Providers in Corvallis, OR by specialty
• General Practice Dentistry in Oregon

• 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.