Advantage Dental Clinics, LLC
Organization Active NPI General Practice Dentistry · Redmond, OR
NPI 1992935357 · NPPES record last updated Sep 23, 2011
Key facts
- NPI
- 1992935357
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- ADVANTAGE DENTAL CLINICS, LLC
- Practice address
- 442 SW Umatilla Ave Ste 200
Redmond, OR 97756-7039 - Phone
- (866) 268-9616
- Fax
- (541) 504-3907
- NPI assigned
- Jul 20, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. R Mike Shirtcliff, DMD
- Title
- President/Ceo/Dental Director
- Phone
- (866) 268-9616
Corporate family (same tax ID) 1
Practitioners 12
-
Natalie Joy Buckley, DMD
-
Taylor Bybee, DDS
-
Dennis Iverson, DDS
-
Giles Looney, D.D.S.
-
Ioane Ofisa, DDS
-
Julian Petersen, DDS
-
Michael Reynolds, DDS
-
Ralph Michael Shirtcliff, D.M.D.
-
James Ryan Surface, DMD
-
Derek S Youngblood, DMD
-
Ryan P Lemert, DMD
National Provider Directory
- Tax ID family
- Advantage Dental Clinics LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
442 SW Umatilla Ave Ste 200
Redmond, OR 97756-7039
Mailing address
PO Box 490
Redmond, OR 97756-0092
Phone (866) 268-9616
NPI Registry JSON
{
"created_epoch": "1248048000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1316736000000",
"number": "1992935357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 490",
"city": "REDMOND",
"state": "OR",
"postal_code": "977560092",
"telephone_number": "866-268-9616",
"fax_number": "541-504-3907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "442 SW UMATILLA AVE STE 200",
"city": "REDMOND",
"state": "OR",
"postal_code": "977567039",
"telephone_number": "866-268-9616",
"fax_number": "541-504-3907"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANTAGE DENTAL CLINICS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-07-20",
"last_updated": "2011-09-23",
"status": "A",
"authorized_official_last_name": "SHIRTCLIFF",
"authorized_official_first_name": "R",
"authorized_official_middle_name": "MIKE",
"authorized_official_title_or_position": "PRESIDENT/CEO/DENTAL DIRECTOR",
"authorized_official_telephone_number": "866-268-9616",
"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": []
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All providers in Redmond, OR · General Practice Dentistry in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.