Active NPI
Deeply Rooted Dentistry, LLC
- General Practice Dentistry
- Bend, OR
National Provider Identifier
1871205393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- DEEPLY ROOTED DENTISTRY, LLC
- Practice address
- 461 NE Greenwood Ave
Suite C
Bend, OR 97701 - Phone
- (541) 678-5060
- Fax
- (541) 306-4004
- NPI assigned
- Dec 15, 2022
- Last updated
- Dec 15, 2022
- Organization subpart
- Yes
- Parent organization
- DEEPLY ROOTED DENTISTRY, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Paul H Kim, DMD
- Title
- Dentist/Owner
- Phone
- (541) 678-5060
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | Primary |
Addresses
Primary practice location
461 NE Greenwood Ave
Suite C
Bend, OR 97701
Mailing address
461 NE Greenwood Ave
Suite C
Bend, OR 97701
Phone (541) 678-5060
Other names 1
- PAUL KIM, DDS
National Provider Directory
National Provider Directory- Part of
- Deeply Rooted Dentistry LLC
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- Bend, OR
- NPI 1477643823
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671062400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1671062400000",
"number": "1871205393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "461 NE GREENWOOD AVE",
"address_2": "SUITE C",
"city": "BEND",
"state": "OR",
"postal_code": "97701",
"telephone_number": "541-678-5060",
"fax_number": "541-306-4004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "461 NE GREENWOOD AVE",
"address_2": "SUITE C",
"city": "BEND",
"state": "OR",
"postal_code": "97701",
"telephone_number": "541-678-5060",
"fax_number": "541-306-4004"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DEEPLY ROOTED DENTISTRY, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DEEPLY ROOTED DENTISTRY, LLC",
"enumeration_date": "2022-12-15",
"last_updated": "2022-12-15",
"certification_date": "2022-12-15",
"status": "A",
"authorized_official_last_name": "KIM",
"authorized_official_first_name": "PAUL",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "DENTIST/OWNER",
"authorized_official_telephone_number": "541-678-5060",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DMD"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "PAUL KIM, DDS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.