MIRROR POND DENTAL, LLC (NPI# 1548719461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548719461 |
| Entity Type | Organization |
| Organization Name | MIRROR POND DENTAL, LLC |
| Practice Address |
1412 Ne 134th St. Suite 120 Vancouver WA 98685 |
| Mailing Address |
1475 Sw Chandler Ave Ste 201 Bend OR 97702-3240 |
| Practice Telephone | 3605734848 |
| Mailing Telephone | 5416107837 |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |
| Authorized Official Name | MARC ANDREW NORDSTROM (MEMBER) |
| Authorized Official Telephone | 5416107837 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | DE60682826 | WA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225401052 | Mirror Pond Dental, LLC | Dentist | 102 Nw Newport Ave, Bend, OR 97703-1838 | 2015-11-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MIRROR POND DENTAL, LLC | 108 Nw Newport Ave, Bend, OR 97703 |
| Street Address |
1412 NE 134TH ST. SUITE 120 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225650112 | Zachary Dodds | Massage Therapist | 12314 Nw 42nd Ct, Vancouver, WA 98685 | 2020-05-13 |
| 1760996425 | Eric Moore | Physical Therapy Assistant | 1308 Ne 134th Street, Suite 110, Vancouver, WA 98685 | 2017-11-16 |
| 1942711767 | Julie B Lawrence | Nurse Practitioner | 900 Ne 139th Street, Suite 202, Vancouver, WA 98685 | 2017-10-19 |
| 1538688668 | Carrie Roxann Wolfe | Counselor | 1313 Ne 134th St Ste 220a, Vancouver, WA 98685 | 2017-09-09 |
| 1629522958 | Deanna Carter | Massage Therapist | 1319 Ne 134th Street, Vancouver, WA 98685 | 2016-08-03 |
| 1417329020 | Kaleen Hoyt | Massage Therapist | 1319 Nw 134th St Suit 103, Vancuver, WA 98685 | 2015-10-22 |
| 1497173066 | Kelley Heffelfinger | Behavioral Analyst | 9901 Ne 7th Ave., Suite C-116, Vancouver, WA 98685 | 2014-04-01 |
| 1548512791 | Elana S Kier | Social Worker | 10000 Ne 7th Ave Ste 100b, Vancouver, WA 98685 | 2012-10-12 |
| 1922370469 | Brian R Timms | Chiropractor | 1412 Ne 134th St Ste 100, Vancouver, WA 98685 | 2012-01-30 |
| 1336436906 | Justin Anthony Heaton | Dentist | 900 Ne 139th St Ste 106, Vancouver, WA 98685 | 2011-07-05 |
| Find all providers in zip 98685 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639787088 | Andrey Vorobets | Dentist | 12403 Ne 20th St, Vancouver, WA 98684-5566 | 2020-07-21 |
| 1689207318 | Beatriz Ellen Fortanely | Dentist | Ubc Faculty of Dentistry, 2151 Wesbrook Mall, Vancouver, BC V6T 1Z3 | 2020-02-21 |
| 1891258711 | Washington Dental Corporation, PC | Dentist | 14411 Ne Fourth Plain, Suite 134, Vancouver, WA 98682 | 2019-04-08 |
| 1356819403 | Kesang Yangchen Norbhu | Dentist | 7202 Ne Highway 99 Ste 100, Vancouver, WA 98665-8932 | 2018-11-07 |
| 1326514803 | Haseeb Hussain | Dentist | 8400 Ne Vancouver Mall Loop Ste 105, Vancouver, WA 98662-6672 | 2018-10-22 |
| 1023584877 | Always Smiles Dentistry | Dentist | 910 Ne Minnehaha St #12, Vancouver, WA 98665 | 2018-10-19 |
| 1730664772 | Thomas Shogo Backus | Dentist | 503 Nw 84th Cir, Vancouver, WA 98665-7720 | 2018-09-25 |
| 1801382387 | Kristopher K Kostenko | Dentist | 14201 Ne 20th Ave Ste A101, Vancouver, WA 98686 | 2018-07-08 |
| 1831699198 | Isabel Ane Sobrado | Dentist | 12425 Ne 20th St, Vancouver, WA 98684-5566 | 2018-02-13 |
| 1689197808 | Shawn P Platt | Dentist | 1300 Esther St Ste 101, Vancouver, WA 98660-2890 | 2017-07-19 |
| Find all providers in VANCOUVER | ||||
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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.