ERIC J DIERKS (NPI# 1265432025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265432025 |
| Entity Type | Individual |
| Full Name | ERIC J DIERKS |
| Credential | MD, DMD |
| Practice Address |
1849 Nw Kearney St Portland OR 97209 |
| Mailing Address |
1849 Nw Kearney St Ste 300 Portland OR 97209-1453 |
| Practice Telephone | 5032241371 |
| Practice Fax Number | 5032240722 |
| Mailing Telephone | 5032241371 |
| Mailing Fax Number | 5032240722 |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2018-06-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgery | D6708 | OR | Allopathic & Osteopathic Physicians |
| Y | 204E00000X | Oral & Maxillofacial Surgery | MD16391 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 008560 | 05 |
| Street Address |
1849 NW KEARNEY ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346249281 | Bryce Earl Potter | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Ste 300, Portland, OR 97209-1453 | 2005-07-20 |
| 1114372653 | Oregon Interventional Pain Consultants, LLC | Clinic/Center | 1849 Nw Kearney St, Suite 201, Portland, OR 97209-1453 | 2016-05-03 |
| 1982940169 | Bret Anthony Wonderlick | Audiologist | 1849 Nw Kearney St, Suite 200, Portland, OR 97209-1453 | 2012-12-17 |
| 1043537707 | Allen C Cheng | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2010-04-21 |
| 1023331469 | Trauma Specialists, LLP | Specialist | 1849 Nw Kearney St, Suite 100, Portland, OR 97209-1453 | 2010-03-11 |
| 1053643023 | Karen Susan Hoyt | Registered Nurse | 1849 Nw Kearney St, Suite 300, Portland, OR 97209-1453 | 2010-02-02 |
| 1730332198 | John David Miller | Dentist | 1849 Nw Kearney St, Suite 200, Portland, OR 97209-1453 | 2008-10-29 |
| 1396918611 | James P Cuyler, M.d., P.C. | Otolaryngology | 1849 Nw Kearney St, Suite 200, Portland, OR 97209-1453 | 2008-04-08 |
| 1528257961 | R Sterling Hodgson Md LLC | Otolaryngology | 1849 Nw Kearney St, Suite 200, Portland, OR 97209-1453 | 2007-10-22 |
| 1043415870 | Ashish A Patel | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2007-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508476250 | Harrington Health Clinic | Nurse Practitioner | 310 Nw Glisan Street, Portland, OR 97209 | 2020-08-07 |
| 1619599636 | Rivers Way Training Clinic | Community/Behavioral Health | 2049 Nw Hoyt, Portland, OR 97209 | 2020-05-13 |
| 1518590538 | Julie Kay Igarta | Registered Nurse | 140 Northwest 14th Avenue, Portland, OR 97209 | 2020-02-18 |
| 1407492002 | Oregon Injection Clinic | Clinic/Center | 1500 Nw Lovejoy, 106, Portland, OR 97209 | 2019-11-19 |
| 1487202883 | Ann Tesora | Massage Therapist | 1320 Northwest 20th Avenue, Portland, OR 97209 | 2019-08-28 |
| 1972160455 | Vincent Martin | Massage Therapist | 210 Sw 17th Avenue, Portland, OR 97209 | 2019-05-21 |
| 1154896546 | Jennifer Marie Dodd | Social Worker | 1722 Nw Raleigh St Spc 412, Portland, OR 97209 | 2018-10-11 |
| 1922551910 | Ashley Crowell | Physician Assistant | 949 Nw Overton St Unit 306, Portland, OR 97209 | 2016-07-26 |
| 1326408394 | Jennifer Blain | Counselor | 324 Nw Davis, Portland, OR 97209 | 2016-03-03 |
| 1275993255 | Lauren Dodson | Licensed Practical Nurse | 324 Nw Davis St, Portland, OR 97209 | 2016-03-03 |
| Find all providers in zip 97209 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346249281 | Bryce Earl Potter | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Ste 300, Portland, OR 97209-1453 | 2005-07-20 |
| 1053864561 | Karl Cuddy | Oral & Maxillofacial Surgery | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2016-08-01 |
| 1104209386 | Felix Wiyanto Sim | Oral & Maxillofacial Surgery | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2015-07-07 |
| 1407109937 | Providence Health & Services - Oregon | Oral & Maxillofacial Surgery | 4805 Ne Glisan St, Suite 6n50, Portland, OR 97213-2933 | 2012-10-22 |
| 1447525852 | Brett A. Ueeck Dmd, Md, PC | Oral & Maxillofacial Surgery | 11786 Sw Barnes Rd Ste 110, Portland, OR 97225-5926 | 2012-03-19 |
| 1588939961 | Marcus Aaron Couey | Oral & Maxillofacial Surgery | 1849 Nw Kearney St Ste 300, Portland, OR 97209-1453 | 2012-03-18 |
| 1043537707 | Allen C Cheng | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2010-04-21 |
| 1043415870 | Ashish A Patel | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2007-06-20 |
| 1235332834 | Daniel Petrisor | Oral & Maxillofacial Surgery | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2007-06-09 |
| 1790889376 | Maine Medical Partners | Oral & Maxillofacial Surgery | 22 Bramhall St, Dept of Surgery, Portland, ME 04102-3134 | 2006-09-12 |
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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.