POLARIS DENTAL SPECIALISTS (NPI# 1548671340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548671340 |
| Entity Type | Organization |
| Organization Name | POLARIS DENTAL SPECIALISTS |
| Other Organization Name | TCD ENDODONTICS |
| Practice Address |
620 12th Street Se Salem OR 97301 |
| Mailing Address |
620 12th St. Se Salem OR 97301 |
| Practice Telephone | 5039915921 |
| Practice Fax Number | 5032551542 |
| Mailing Telephone | 5039915921 |
| Mailing Fax Number | 5032551542 |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2017-06-19 |
| Authorized Official Name | TUONG NGUYEN NGUYEN (OWNER) |
| Authorized Official Telephone | 5033274396 |
| Authorized Official Credential | BDS, MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers | ||
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
D9058 | OR | Dental Providers |
| Other Name | Type Code |
|---|---|
| TCD Endodontics | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | POLARIS DENTAL SPECIALISTS LLC | 925 Commercial St Se Ste 240, Salem, OR 97302 |
| Street Address |
620 12TH STREET SE |
| City | SALEM |
| State | OR |
| Zip Code | 97301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
| 1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
| 1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
| 1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
| 1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
| 1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
| 1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
| 1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
| 1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
| 1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
| Find all providers in zip 97301 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386069151 | Tcd Endodontics | Dentist | 620 12th St. Se, Salem, OR 97301 | 2014-03-03 |
| 1003941170 | Jefferson B Gourley | Dentist | 142 Pembrook St Se, Salem, OR 97302-5038 | 2007-02-22 |
| 1811088222 | Lisa Beth Wipf | Dentist | 3389 Center St Ne, Salem, OR 97301 | 2006-09-28 |
| 1730198359 | Endodontics Inc | Dentist | 2 Winter St, Salem, MA 01970-3807 | 2006-08-05 |
| 1457369969 | Chris J Bowman | Dentist | 830 Liberty St Ne, Salem, OR 97301-2450 | 2006-08-03 |
| 1316962913 | Marvin E. Thews Jr. | Dentist | 1940 Braeburn Dr, Salem, VA 24153-7383 | 2006-07-13 |
| 1891789376 | Kevin Roy Christiansen | Dentist | 4342 Liberty Rd S, Salem, OR 97302-6171 | 2005-09-09 |
| 1922647312 | - | Dentist | 4342 Liberty Rd S, Salem, OR 97302-6171 | 2020-01-02 |
| 1558779579 | David Cheung-fai Lau | Dentist | 620 12th St. Se, Salem, OR 97301 | 2014-07-23 |
| 1801216643 | Willamette Valley Endodontics, PC | Dentist | 805 High St Ne, Salem, OR 97301-2442 | 2014-04-20 |
| 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.