NPIMap

Organization Active NPI

Rogue Valley Dental Center LLC

  • General Practice Dentistry
  • Medford, OR
National Provider Identifier
1871900365
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ROGUE VALLEY DENTAL CENTER LLC
Practice address
1150 Crater Lake Ave
Suite E
Medford, OR 97504-6213
Phone
(541) 779-4517
Fax
(541) 779-4605
NPI assigned
Jul 16, 2014
Last updated
Jul 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Authorized official

Name
Dr. Keith BergNPI 1811021934
Title
Owner
Phone
(541) 779-4517

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)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1150 Crater Lake Ave
Suite E
Medford, OR 97504-6213

Mailing address

1150 Crater Lake Ave
Suite E
Medford, OR 97504-6213
Phone (541) 779-4517

National Provider Directory

National Provider Directory
Tax ID family
Rogue Valley Dental Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1871900365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 CRATER LAKE AVE",
            "address_2": "SUITE E",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046213",
            "telephone_number": "541-779-4517",
            "fax_number": "541-779-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 CRATER LAKE AVE",
            "address_2": "SUITE E",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046213",
            "telephone_number": "541-779-4517",
            "fax_number": "541-779-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE VALLEY DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-779-4517",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; 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.