Active NPI
Falon Nicole Poureetezadi, EFDA
- Dental Assistant
- Gresham, OR
National Provider Identifier
1013309038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 120537
- Practice address
- 360 NW Burnside Rd
Gresham, OR 97030-3852 - Phone
- (503) 667-7480
- NPI assigned
- Feb 27, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 120537 | OR | Primary |
Addresses
Primary practice location
360 NW Burnside Rd
Gresham, OR 97030-3852
Mailing address
900 SE Arrow Creek LN
Gresham, OR 97080-1981
Phone (503) 201-0146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120537 | OR | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424995200000",
"number": "1013309038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 SE ARROW CREEK LN",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970801981",
"telephone_number": "503-201-0146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 NW BURNSIDE RD",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303852",
"telephone_number": "503-667-7480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POUREETEZADI",
"first_name": "FALON",
"middle_name": "NICOLE",
"credential": "EFDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-27",
"last_updated": "2015-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "OR",
"license": "120537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.