1. Home
  2. Directory
  3. Oregon
  4. Ontario
  5. Dentist
  6. NPI Profile
  7. NPI Record 1609043157

EASTERN OREGON DENTAL CLINIC LLC
Complete NPI Record 1609043157
Dentist - General Practice in Ontario, OR

NPI Status: Active since May 14, 2008

Contact Information

475 SW 12TH ST
ONTARIO, OR
ZIP 97914
Phone: (541) 881-1794
Fax: (541) 889-2904

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Healthcare Provider Taxonomy Code 2
  31. Provider License Number 2
  32. Provider License Number State Code 2
  33. Healthcare Provider Primary Taxonomy Switch 2
  34. Healthcare Provider Taxonomy Code 3
  35. Provider License Number 3
  36. Provider License Number State Code 3
  37. Healthcare Provider Primary Taxonomy Switch 3
  38. Healthcare Provider Taxonomy Code 4
  39. Provider License Number 4
  40. Provider License Number State Code 4
  41. Healthcare Provider Primary Taxonomy Switch 4
  42. Healthcare Provider Taxonomy Code 5
  43. Provider License Number 5
  44. Provider License Number State Code 5
  45. Healthcare Provider Primary Taxonomy Switch 5
  46. Healthcare Provider Taxonomy Code 6
  47. Provider License Number 6
  48. Provider License Number State Code 6
  49. Healthcare Provider Primary Taxonomy Switch 6
  50. Healthcare Provider Taxonomy Code 7
  51. Provider License Number 7
  52. Provider License Number State Code 7
  53. Healthcare Provider Primary Taxonomy Switch 7
  54. Healthcare Provider Taxonomy Code 8
  55. Provider License Number 8
  56. Provider License Number State Code 8
  57. Healthcare Provider Primary Taxonomy Switch 8
  58. Healthcare Provider Taxonomy Code 9
  59. Provider License Number 9
  60. Provider License Number State Code 9
  61. Healthcare Provider Primary Taxonomy Switch 9
  62. Healthcare Provider Taxonomy Code 10
  63. Provider License Number 10
  64. Provider License Number State Code 10
  65. Healthcare Provider Primary Taxonomy Switch 10
  66. Healthcare Provider Taxonomy Code 11
  67. Provider License Number 11
  68. Provider License Number State Code 11
  69. Healthcare Provider Primary Taxonomy Switch 11
  70. Healthcare Provider Taxonomy Code 12
  71. Provider License Number 12
  72. Provider License Number State Code 12
  73. Healthcare Provider Primary Taxonomy Switch 12
  74. Healthcare Provider Taxonomy Code 13
  75. Provider License Number 13
  76. Provider License Number State Code 13
  77. Healthcare Provider Primary Taxonomy Switch 13
  78. Healthcare Provider Taxonomy Code 14
  79. Provider License Number 14
  80. Provider License Number State Code 14
  81. Healthcare Provider Primary Taxonomy Switch 14
  82. Healthcare Provider Taxonomy Code 15
  83. Provider License Number 15
  84. Provider License Number State Code 15
  85. Healthcare Provider Primary Taxonomy Switch 15
  86. Is Organization Subpart
  87. Authorized Official Name Prefix Text
  88. Authorized Official Credential Text
  89. Healthcare Provider Taxonomy Group 1
  90. Healthcare Provider Taxonomy Group 2
  91. Healthcare Provider Taxonomy Group 3
  92. Healthcare Provider Taxonomy Group 4
  93. Healthcare Provider Taxonomy Group 5
  94. Healthcare Provider Taxonomy Group 6
  95. Healthcare Provider Taxonomy Group 7
  96. Healthcare Provider Taxonomy Group 8
  97. Healthcare Provider Taxonomy Group 9
  98. Healthcare Provider Taxonomy Group 10
  99. Healthcare Provider Taxonomy Group 11
  100. Healthcare Provider Taxonomy Group 12
  101. Healthcare Provider Taxonomy Group 13
  102. Healthcare Provider Taxonomy Group 14
  103. Healthcare Provider Taxonomy Group 15

Complete NPI Dataset

This page represents the complete record for NPI 1609043157. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1609043157
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 478 SW 12TH ST
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: ONTARIO
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OR
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 979143202
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5418811794
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 5418892904
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 475 SW 12TH ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ONTARIO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OR
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 979143201
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5418811794
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 5418892904
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/14/2008
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/14/2008
The date that a record was last updated or changed.
Authorized Official Last Name: DAHLE
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: ERIC
The first name of the authorized official.
Authorized Official Middle Name: N
The middle name of the authorized official.
Authorized Official Title or Position: MEMBER
The title or position of the authorized official.
Authorized Official Telephone Number: 5418811794
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 122300000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: D9048
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: OR
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 122300000X
Provider License Number 2: D6574
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: OR
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 122300000X
Provider License Number 3: D7219
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: OR
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 1223E0200X
Provider License Number 4: D9048
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: OR
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 1223E0200X
Provider License Number 5: D6574
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: OR
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 1223E0200X
Provider License Number 6: D7219
Provider License Number State Code 6: OR
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 1223G0001X
Provider License Number 7: D9048
Provider License Number State Code 7: OR
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 1223G0001X
Provider License Number 8: D7219
Provider License Number State Code 8: OR
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 1223P0300X
Provider License Number 9: D6574
Provider License Number State Code 9: OR
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 1223P0300X
Provider License Number 10: D9048
Provider License Number State Code 10: OR
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 1223P0300X
Provider License Number 11: D7219
Provider License Number State Code 11: OR
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 1223S0112X
Provider License Number 12: D9048
Provider License Number State Code 12: OR
Healthcare Provider Primary Taxonomy Switch 12: N
Healthcare Provider Taxonomy Code 13: 1223S0112X
Provider License Number 13: D6574
Provider License Number State Code 13: OR
Healthcare Provider Primary Taxonomy Switch 13: N
Healthcare Provider Taxonomy Code 14: 1223S0112X
Provider License Number 14: D7219
Provider License Number State Code 14: OR
Healthcare Provider Primary Taxonomy Switch 14: N
Healthcare Provider Taxonomy Code 15: 1223G0001X
Provider License Number 15: D6574
Provider License Number State Code 15: OR
Healthcare Provider Primary Taxonomy Switch 15: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: DMD
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 11: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 12: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 13: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 14: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 15: 193400000X MULTIPLE SINGLE SPECIALTY GROUP