Moustapha Sy, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11230 Issued in OR

Practice address

16755 SW Baseline Rd Ste 106
Beaverton, OR 97006-4284

Phone

(503) 352-5450

Fax

(503) 746-5448

NPI assigned

Jun 5, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 5 Star Smiles Dentistry

  • Dentist
  • Beaverton, OR
  • NPI 1003574336
  NPD Authorized official

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1043834997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16755 SW BASELINE RD STE 106",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064284",
            "telephone_number": "503-352-5450",
            "fax_number": "503-746-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16755 SW BASELINE RD STE 106",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064284",
            "telephone_number": "503-352-5450",
            "fax_number": "503-746-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SY",
        "first_name": "MOUSTAPHA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-05",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11230",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "11230",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "FAX",
            "affiliation": "N",
            "address_1": "16755 SW Baseline Rd Ste 106",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970064284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shayna Swan, LMT
• Kim Raymond Swartz, M.D.
• Christina Swayne, EFDA
• Sherry L Sweeney, CPNP
• Carol Swope
• Synapse Kids LLC
• Synergy Counseling LLC
• Joann Kim Ta
• Joshua Alexander Tabaldo
• Shannon Tabbal

• All providers in Beaverton, OR
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.