IDYLWOOD DENTAL LLC (NPI# 1437643616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437643616 |
| Entity Type | Organization |
| Organization Name | IDYLWOOD DENTAL LLC |
| Practice Address |
4392 Liberty Road Salem OR 97302-6171 |
| Mailing Address |
Po Box 3000 Salem OR 97302-8001 |
| Practice Telephone | 5033152500 |
| Practice Fax Number | 5033157227 |
| Mailing Telephone | 8005442345 |
| Mailing Fax Number | 5033157227 |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | EDGAR MERZENICH (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 5033152500 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
4063 | OR | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | IDYLWOOD DENTAL LLC | 4392 Liberty Rd S, Salem, OR 97302 |
| Street Address |
4392 LIBERTY ROAD |
| City | SALEM |
| State | OR |
| Zip Code | 97302-6171 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
| Find all providers in zip 97302 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811557457 | Chadi Farag | Dentist | 25620 75th Street, Salem, WI 53168 | 2019-06-17 |
| 1528626660 | Stephanie Danielle Gibbons | Dentist | 5 Dawn St, Salem, NH 03079-3231 | 2019-06-04 |
| 1407414642 | Selma Moon Pierce | Dentist | 961 Glen Eden Ct Nw, Salem, OR 97304-2258 | 2019-06-03 |
| 1295392926 | Brock Jesse Nelson | Dentist | 631 Jason St Ne Ste 150, Salem, OR 97301-2750 | 2019-05-29 |
| 1023595899 | Gregory Lee Miller | Dentist | 3405 Derr Park Rd Se, Salem, OR 97310-0001 | 2018-07-25 |
| 1619428281 | William D. Bateman, Dmd, LLC | Dentist | 1995 Commercial St Se Ste 200, Salem, OR 97302-5291 | 2016-10-19 |
| 1134545494 | Caroline Wallace | Dentist | 103 S Colorado St, Salem, VA 24153-3848 | 2014-03-11 |
| 1275960296 | Amy Trevor | Dentist | 1595 Commercial St. Se, Salem, OR 97302 | 2013-10-04 |
| 1558601385 | Crisdental East Salem, LLC | Dentist | 3545 Lancaster Dr Ne, Salem, OR 97305-1435 | 2013-02-14 |
| 1487929980 | King Dental PC | Dentist | 1855 W Nob Hill St Se Ste 200, Salem, OR 97302-5288 | 2012-03-15 |
| 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.