NPIMap

Organization Active NPI

Mid-Valley Dental Associates, LLC

  • General Practice Dentistry
  • Albany, OR
National Provider Identifier
1700029709
Registry record updated Apr 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D7915 Issued in OR
Legal business name
MID-VALLEY DENTAL ASSOCIATES, LLC
Practice address
2825 Willetta St SW
Suite a
Albany, OR 97321-3846
Phone
(541) 928-2301
Fax
(541) 928-8493
NPI assigned
Apr 7, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2009

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

Authorized official

Name
Susan M. Baham
Title
Office Manager
Phone
(541) 928-2301

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D7915 OR Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D8673 OR
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D9084 OR
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D9107 OR

Addresses

Primary practice location

2825 Willetta St SW
Suite a
Albany, OR 97321-3846

Mailing address

2825 Willetta St SW
Suite a
Albany, OR 97321-3846
Phone (541) 928-2301

National Provider Directory

National Provider Directory
Tax ID family
Mid-Valley Dental Associates LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2825 Willetta St SW
Ste A
Albany, OR 97321
Phone (541) 928-2301

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1700029709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 WILLETTA ST SW",
            "address_2": "SUITE A",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973213846",
            "telephone_number": "541-928-2301",
            "fax_number": "541-928-8493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 WILLETTA ST SW",
            "address_2": "SUITE A",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973213846",
            "telephone_number": "541-928-2301",
            "fax_number": "541-928-8493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-07",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "BAHAM",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-928-2301"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7915",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8673",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9084",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9107",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.