Provider Demographics
NPI:1043869191
Name:ACORN DENTISTRY FOR KIDS - WEST SALEM, LLC
Entity Type:Organization
Organization Name:ACORN DENTISTRY FOR KIDS - WEST SALEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-874-4560
Mailing Address - Street 1:204 N 1ST ST STE E
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1635
Mailing Address - Country:US
Mailing Address - Phone:503-874-4560
Mailing Address - Fax:
Practice Address - Street 1:1049 EDGEWATER ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4046
Practice Address - Country:US
Practice Address - Phone:503-874-4560
Practice Address - Fax:503-874-4562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty