MIRROR POND DENTAL, LLC
NPI 1225401052
Dentist - General Practice in Bend, OR

Q: What is Mirror Pond Dental, LLC's NPI number?

The NPI number for Mirror Pond Dental, LLC is 1225401052. It was assigned to this organization in the NPPES registry on November 2, 2015.

Q: What is Mirror Pond Dental, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since November 02, 2015

102 NW NEWPORT AVE, BEND, OR 97703(541) 382-2256(541) 389-5229 Get Directions Write a Review

NPPES record last updated: November 2, 2015. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Mirror Pond Dental, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIRROR POND DENTAL, LLC (NPI 1225401052) is a healthcare organization registered as a general practice in Bend, Oregon and active in the NPI registry since November 2015. The organization lists Marc Nordstrom, Owner, as its authorized official.

NPPES Registry Identity

NPI1225401052

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameMIRROR POND DENTAL, LLC

Location Address102 NW NEWPORT AVEBend, OR 97703-1838

Mailing Address102 Nw Newport AveBend, OR 97703-1838 · (541) 382-2256 · Fax (541) 389-5229

Phone(541) 382-2256

Fax(541) 389-5229

Organization SubpartNo

Authorized OfficialMarc NordstromOwner · (541) 382-2256

Enumeration DateNovember 2, 2015

✔ NPI 1225401052 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in OR · D7335

Definition

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.

102 NW NEWPORT AVE, Bend, OR 97703

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEALTHY ROOTS ENDODONTICS LLC

Dentist (Endodontics)

102 NW NEWPORT AVE
BEND, OR 97703

Deschutes County (970) 214-9412

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mirror Pond Dental, LLC's NPI number?

The NPI number for Mirror Pond Dental, LLC is 1225401052. It was assigned to this organization in the NPPES registry on November 2, 2015.

Where is Mirror Pond Dental, LLC located?

Mirror Pond Dental, LLC is located at 102 NW Newport Ave, Bend, OR 97703. The listed phone number is (541) 382-2256.

What is Mirror Pond Dental, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Mirror Pond Dental, LLC was last updated on November 2, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.