Kathleene G Adams, DMD
Individual provider Active NPI Dentist · Portland, OR
NPI 1063582252 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1063582252
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5148 (OR)
- Practice address
- 419 NW 23Rd Ave
Suite 102
Portland, OR 97210 - Phone
- (503) 224-2273
- Fax
- (503) 224-1176
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160307001720 | OR | Order and Referring Only - Oral Surgery |
7315243037 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5148 | OR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westover Dental Clinic | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5148 | OR | Yes |
Addresses
Primary practice location
419 NW 23Rd Ave
Suite 102
Portland, OR 97210
Mailing address
419 NW 23Rd Ave
Suite 102
Portland, OR 97210
Phone (503) 224-2273
Other names
- Kathleene G Adams Belusko
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.