NPIMap

Organization Active NPI

Birch Avenue Dental, Inc.

  • Dentist
  • Cottage Grove, OR
National Provider Identifier
1841363348
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D6947 Issued in OR
Legal business name
BIRCH AVENUE DENTAL, INC.
Practice address
1325 Birch Ave
Cottage Grove, OR 97424-1416
Phone
(541) 942-2471
Fax
(541) 942-9318
NPI assigned
Nov 15, 2006
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
Dr. Park W McClung, D.D.S.NPI 1144393646
Title
President
Phone
(541) 942-2471

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 D6947 OR Primary

Addresses

Primary practice location

1325 Birch Ave
Cottage Grove, OR 97424-1416

Mailing address

1325 Birch Ave
Cottage Grove, OR 97424-1416
Phone (541) 942-2471

National Provider Directory

National Provider Directory

Locations

1325 Birch Ave
Cottage Grove, OR 97424
Phone (541) 942-2471

Practitioners & affiliated clinicians

Practitioners 2

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": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841363348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 BIRCH AVE",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974241416",
            "telephone_number": "541-942-2471",
            "fax_number": "541-942-9318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 BIRCH AVE",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974241416",
            "telephone_number": "541-942-2471",
            "fax_number": "541-942-9318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH AVENUE DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCLUNG",
        "authorized_official_first_name": "PARK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-942-2471",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottage Grove, 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.