NPIMap

Organization Active NPI

Cedar Hills Modern Dentistry, PC

  • General Practice Dentistry
  • Beaverton, OR
National Provider Identifier
1043724917
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CEDAR HILLS MODERN DENTISTRY, PC
Practice address
2905 SW Cedar Hills Blvd Ste 120
Beaverton, OR 97005-1342
Phone
(503) 396-4071
Fax
(503) 396-4071
NPI assigned
Nov 29, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Dr. Kenny Tran, DMDNPI 1396223954
Title
Owner Dentist
Phone
(503) 396-4071

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2905 SW Cedar Hills Blvd Ste 120
Beaverton, OR 97005-1342

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8500

Other names 1

  • Cedar Hills Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

2905 SW Cedar Hills Blvd
Ste 120
Beaverton, OR 97005
Phone (503) 396-4071

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1043724917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8500",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2905 SW CEDAR HILLS BLVD STE 120",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051342",
            "telephone_number": "503-396-4071",
            "fax_number": "503-396-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR HILLS MODERN DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-29",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "503-396-4071",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Hills Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cedar Hills Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.