NPIMap

Organization Active NPI

Kenneth G Mize Dmdpc

  • Dentist
  • Sheridan, OR
National Provider Identifier
1801918255
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D5811 Issued in OR
Legal business name
KENNETH G MIZE DMDPC
Practice address
411 W Main St
Sheridan, OR 97378-1117
Phone
(503) 843-4433
Fax
(503) 843-4434
NPI assigned
Apr 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kenneth G Mize, DMDNPI 1255338638
Title
President
Phone
(503) 843-4433

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D5811 OR Primary

Addresses

Primary practice location

411 W Main St
Sheridan, OR 97378-1117

Mailing address

411 W Main St
P.O. Box 100
Sheridan, OR 97378-1117
Phone (503) 843-4433

National Provider Directory

National Provider Directory

Locations

411 W Main St
Sheridan, OR 97378
Phone (503) 843-4433

Practitioners & affiliated clinicians

Practitioners 1

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": "1175731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801918255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W MAIN ST",
            "address_2": "P.O. BOX 100",
            "city": "SHERIDAN",
            "state": "OR",
            "postal_code": "973781117",
            "telephone_number": "503-843-4433",
            "fax_number": "503-843-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W MAIN ST",
            "city": "SHERIDAN",
            "state": "OR",
            "postal_code": "973781117",
            "telephone_number": "503-843-4433",
            "fax_number": "503-843-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH G MIZE DMDPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MIZE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-843-4433",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D5811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheridan, OR

Sources for this page

  • 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.