ACORN DENTISTRY FOR KIDS - WEST SALEM, LLC (NPI# 1043869191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043869191 |
| Entity Type | Organization |
| Organization Name | ACORN DENTISTRY FOR KIDS - WEST SALEM, LLC |
| Practice Address |
1049 Edgewater St Nw Salem OR 97304-4046 |
| Mailing Address |
204 N 1st St Ste E Silverton OR 97381-1635 |
| Practice Telephone | 5038744560 |
| Practice Fax Number | 5038744562 |
| Mailing Telephone | 5038744560 |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2019-09-10 |
| Authorized Official Name | TIMOTHY RICHARDSON (OWNER) |
| Authorized Official Telephone | 5038744560 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Acorn Dentistry for Kids - West Salem | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | ACORN DENTISTRY FOR KIDS - WEST SALEM, LLC | 714 Hicks St, Silverton, OR 97381 |
| Street Address |
1049 EDGEWATER ST NW |
| City | SALEM |
| State | OR |
| Zip Code | 97304-4046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124331392 | Xi Zheng | Internal Medicine | 1049 Edgewater St Nw, Salem, OR 97304-4046 | 2010-07-16 |
| 1316424583 | Robert Allan Hiester | Nurse Practitioner | 1049 Edgewater St Nw, Salem, OR 97304-4046 | 2018-07-20 |
| 1033626106 | Brenda Achieng Ndunda | Nurse Practitioner | 1049 Edgewater St Nw, Salem, OR 97304-4046 | 2018-01-10 |
| 1982119848 | Jordan A Biehle | Nurse Practitioner | 1049 Edgewater St Nw, Salem, OR 97304-4046 | 2017-12-13 |
| 1487037172 | Adrian Dryden | Family Medicine | 1049 Edgewater St Nw, Salem, OR 97304-4046 | 2015-06-30 |
| 1558770420 | Casey Leigh Hazenberg | Nurse Practitioner | 1049 Edgewater St Nw, Salem, OR 97304-4046 | 2014-08-05 |
| 1063855864 | Kerrie E. Spicer | Registered Nurse | 1049 Edgewater St Nw, Salem, OR 97304-4046 | 2013-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114413010 | Sam Mackenzie Lane | Massage Therapist | 1661 Edgewater St Nw # 120, Salem, Or 97304, Salem, OR 97304 | 2018-07-03 |
| 1144761131 | Rachel E Carson | Physical Therapist | 1025 2nd St. Nw, West Salem, OR 97304 | 2017-03-10 |
| 1962951061 | Lee Ann Nail | Social Worker | 3965 Gibson Rd Nw, Salem, OR 97304 | 2016-09-29 |
| 1619421591 | Logan Walters | Physical Therapist | 1025 2nd St Nw, Salem, OR 97304 | 2016-08-09 |
| 1770941338 | Tysandra Gillis | Massage Therapist | 859 Mule Deer St., Salem, OR 97304 | 2016-02-10 |
| 1144620295 | Molly Rodden | Nurse Practitioner | 1174 Cornucopia St Nw Ste 240, Salem, OR 97304 | 2014-08-26 |
| 1881942126 | Cynthia Ruth Rettler | Registered Nurse | 1520 Plaza St Nw Ste 150, Salem, OR 97304 | 2012-08-16 |
| 1336401017 | Trillium Family Services | Community/Behavioral Health | 1520 Plaza Street Nw, Suite 100, Salem, OR 97304 | 2012-06-08 |
| 1033428198 | Kathleen Ketelson | Nurse Practitioner | 560 Wallace Rd Nw Ste 140, Salem, OR 97304 | 2010-10-06 |
| 1922332535 | Robert Scott Mcadam | Social Worker | 1245 Edgewater St. Nw, Salem, OR 97304 | 2009-09-29 |
| Find all providers in zip 97304 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740670009 | Ian Bell | Dentist | 140 Ramsgate Sq S Ste 120, Salem, OR 97302-5873 | 2015-01-26 |
| 1942551791 | Roger C. Dow, Dmd PC | Dentist | 140 Ramsgate Sq Se, Suite 110, Salem, OR 97302 | 2012-09-19 |
| 1598821944 | Weston Willard Heringer Jr. | Dentist | 2020 Commercial St Se, Salem, OR 97302 | 2006-12-29 |
| 1003917410 | Jeffrey C Phillips | Dentist | 1109 Liberty Circle S, Salem, OR 97306 | 2006-09-26 |
| 1922112333 | Roger Charles Dow | Dentist | 140 Ramsgate Sq S, Suite 110, Salem, OR 97302-5871 | 2006-08-19 |
| 1457376782 | Sean A Cooper | Dentist | 1105 12th St Se, Salem, OR 97302-2810 | 2006-07-13 |
| 1235116419 | J Chris Martin | Dentist | 1625 Commercial St Se, Salem, OR 97302-4311 | 2005-12-28 |
| 1376530535 | Stuart S Gould | Dentist | 116 Highland Ave, Salem, MA 01970-2723 | 2005-10-03 |
| 1598320111 | Salem Family Dental and Orthodontics PC | Dentist | 10 Federal St Ste 16, Salem, MA 01970-3875 | 2019-05-08 |
| 1841763513 | Swan Pediatric Dental | Dentist | 601 N State Road 198, Salem, UT 84653-4504 | 2019-01-06 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.