Stillwater Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

STILLWATER DENTAL, LLC

Practice address

199 SW Shevlin Hixon Dr Ste a
Bend, OR 97702-3201

Phone

(547) 330-5952

NPI assigned

Nov 27, 2018

Last updated

Aug 14, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Jensen, DMDNPI 1104825363

Title

Owner/Dentist

Phone

(541) 330-5952

Specialties & licenses 1

Addresses

Other names 1

• Mark E. Jensen, DMD, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 3

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.

• Mark E. Jensen, DMD

  • General Practice Dentistry
  • Bend, OR
  • NPI 1104825363
  NPD Authorized official
• Tran Bao Quach-Miller, DMD

  • Dentist
  • Bend, OR
  • NPI 1265412126
  NPD
• Rachel Lynn Mendazona, DMD

  • Dentist
  • Phoenix, AZ
  • NPI 1942925318
  NPD (past)

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

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565740800000",
    "number": "1912477522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 SW SHEVLIN HIXON DR STE A",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 SW SHEVLIN HIXON DR STE A",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023201",
            "telephone_number": "547-330-5952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-27",
        "last_updated": "2019-08-14",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "541-330-5952",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark E. Jensen, DMD, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• John Stewart
• Karen J Stewart, MA
• Morgan Evette Stewart, DPT
• Still Point Counseling, LLC
• Still Point Osteopathy and Medical Acupuncture, LLC
• Justin Lee Stimac, M.D.
• Lara E Stock, NP
• Taylor Rose Stockton, DNP, FNP
• Mathias L Stoenescu, MD
• Albert James Stone, MD

• Dentist in Bend, OR
• Providers in Bend, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.