Mid-Valley Dental Associates Corvallis LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MID-VALLEY DENTAL ASSOCIATES CORVALLIS LLC

Practice address

2300 NW Kings Blvd
Corvallis, OR 97330-3925

Phone

(541) 754-2214

Fax

(541) 754-6631

NPI assigned

Apr 7, 2016

Organization subpart

Yes

Parent organization

MID-VALLEY DENTAL ASSOCIATES LLCAs reported in NPPES

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

Authorized official

Name

Mandy Kay Dittmer

Title

Practice Manager

Phone

(541) 928-2301

Specialties & licenses 1

Addresses

Part of

Mid-Valley Dental Associates LLC

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lenore S Hata, DDS

  • General Practice Dentistry
  • Corvallis, OR
  • NPI 1407913825
  NPD (past)
• Brian Dale Tidwell, DDS

  • General Practice Dentistry
  • Albany, OR
  • NPI 1447418215
  NPD (past)

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1992169742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 WILLETTA ST SW",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973213846",
            "telephone_number": "541-928-2301",
            "fax_number": "541-928-8493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 NW KINGS BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303925",
            "telephone_number": "541-754-2214",
            "fax_number": "541-754-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY DENTAL ASSOCIATES CORVALLIS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MID-VALLEY DENTAL ASSOCIATES LLC",
        "enumeration_date": "2016-04-07",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "DITTMER",
        "authorized_official_first_name": "MANDY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "541-928-2301"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael D Klautzsch, OD, PC
• Michael Sorah
• Christopher I Michel, PA-C
• Emily Michele
• Michelle Hayes LCSW, LLC
• Mid-Valley Healthcare, Inc.
• Mid-Willamette Valley Transgender Support Network
• Katharine Middendorf, PH.D.
• Angela Mierau, LCSW
• Luke Mierau, PA-C

• General Practice Dentistry in Corvallis, OR
• Providers in Corvallis, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; 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.