NPIMap

Organization Active NPI

Gehred Family Dental

Doing business as Wilshire Family Dental

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1043528169
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9242 Issued in OR
Legal business name
GEHRED FAMILY DENTAL
Doing business as
Wilshire Family Dental
Practice address
4839 NE 42ND Ave
Portland, OR 97218-1609
Phone
(503) 284-6469
Fax
(503) 288-0490
NPI assigned
Sep 23, 2010
Last updated
Sep 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cornelius Gehred, DDS
Title
President
Phone
(503) 284-6469

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D9242 OR Primary

Addresses

Primary practice location

4839 NE 42ND Ave
Portland, OR 97218-1609

Mailing address

4839 NE 42ND Ave
Portland, OR 97218-1609
Phone (503) 284-6469

Other names 1

  • Wilshire Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Gehred Family Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4839 NE 42nd Ave
Portland, OR 97218
Phone (503) 284-6469

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285200000000",
    "number": "1043528169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4839 NE 42ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972181609",
            "telephone_number": "503-284-6469",
            "fax_number": "503-288-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4839 NE 42ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972181609",
            "telephone_number": "503-284-6469",
            "fax_number": "503-288-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEHRED FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-23",
        "last_updated": "2010-09-23",
        "status": "A",
        "authorized_official_last_name": "GEHRED",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-284-6469",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilshire Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.