Corvallis Family Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CORVALLIS FAMILY DENTISTRY, LLC

Practice address

1829 NW Kings Blvd
Corvallis, OR 97330-1907

Phone

(541) 752-5048

Fax

(541) 752-9213

NPI assigned

Jan 6, 2012

Organization subpart

No

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

Authorized official

Name

Brian D Tidwell, D.D.S

Title

Dentist

Phone

(541) 929-5227

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325808000000",
    "number": "1730459892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1829 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301907",
            "telephone_number": "541-752-5048",
            "fax_number": "541-752-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1829 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301907",
            "telephone_number": "541-752-5048",
            "fax_number": "541-752-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORVALLIS FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-06",
        "last_updated": "2012-01-06",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "541-929-5227",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corvallis Clinic PC
• Corvallis Clinic PC
• Corvallis Daytime Drop-in Center
• Corvallis Dental Group Inc
• Corvallis Eye Care
• Corvallis Family Medicine PC
• Corvallis Gastroenterology PC
• Corvallis Homeless Shelter Coalition
• Corvallis Internal Medicine, PC
• Corvallis Medical Group LLC

• 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 Jan 6, 2012; 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.