NPIMap

Organization Active NPI

Willamette Dental Group

  • Dentist
  • Salem, OR
National Provider Identifier
1992182026
Registry record updated Apr 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D8124 Issued in OR
Legal business name
WILLAMETTE DENTAL GROUP
Practice address
3490 Lancaster Dr NE
Salem, OR 97305-1356
Phone
(503) 540-9041
NPI assigned
Apr 27, 2015
Last updated
Apr 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2015

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

Authorized official

Name
Ms. Camille Stark
Title
CPCS Credentialing Specialist
Phone
(503) 952-2125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D8124 OR Primary

Addresses

Primary practice location

3490 Lancaster Dr NE
Salem, OR 97305-1356

Mailing address

6950 NE Campus Way
Hillsboro, OR 97124-5611

National Provider Directory

National Provider Directory
Tax ID family
Willamette Dental Group PC22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

3490 Lancaster Dr NE
Salem, OR 97305
Phone (503) 540-9041

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1992182026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3490 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051356",
            "telephone_number": "503-540-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-27",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "CPCS CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "503-952-2125",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; 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.