Mid-Valley Dental Associates, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7915 Issued in OR

Legal business name

MID-VALLEY DENTAL ASSOCIATES, LLC

Practice address

3385 Center St NE
Salem, OR 97301-4609

Phone

(503) 585-2030

Fax

(541) 929-7649

NPI assigned

Aug 12, 2011

Last updated

Aug 12, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

MID-VALLEY DENTAL ASSOCIATESAs reported in NPPES

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

Authorized official

Name

Shawn R Griffin

Title

Administrator

Phone

(541) 929-5227

Specialties & licenses 6

Addresses

Tax ID family

Mid-Valley Dental Associates LLC3 organizations share this tax ID, including this one

Part of

Mid-Valley Dental Associates LLC

Other organizations with this tax ID 2

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

• Mid-Valley Dental Associates

  • Dentist
  • Philomath, OR
  • NPI 1194176016
  NPD tax ID
• Mid-Valley Dental Associates, LLC

  • General Practice Dentistry
  • Albany, OR
  • NPI 1700029709
  NPD tax ID

Locations

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313107200000",
    "number": "1700165362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3385 CENTER ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014609",
            "telephone_number": "503-585-2030",
            "fax_number": "541-929-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3385 CENTER ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014609",
            "telephone_number": "503-585-2030",
            "fax_number": "541-929-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MID-VALLEY DENTAL ASSOCIATES",
        "enumeration_date": "2011-08-12",
        "last_updated": "2011-08-12",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-929-5227"
    },
    "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": "D9107",
            "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": "D9451",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9586",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9614",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mid Valley Medical Home LLC (Mid Valley Physicians Home Health)
• Mid Valley SRTF LLC
• Mid-Valley Oral, Maxillofacial & Implant Surgery
• Mid-Willamette Family and Individual Therapy Services LLC
• Mid-Willamette Valley Community Action Agency, Inc
• Midwife Lennon LLC
• Holly Leah Miguel, FNP

• General Practice Dentistry in Salem, OR
• Providers in Salem, 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 12, 2011; 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.