Mastaneh Pournaderi, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

D8516 Issued in OR

Practice address

12710 SE Division St
Portland, OR 97236-3134

Phone

(503) 988-3410

NPI assigned

Sep 4, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1283558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283558400000",
    "number": "1063729523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14820 NW TRANQUILITY DR",
            "city": "BANKS",
            "state": "OR",
            "postal_code": "971068835",
            "telephone_number": "503-324-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12710 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363134",
            "telephone_number": "503-988-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POURNADERI",
        "first_name": "MASTANEH",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-04",
        "last_updated": "2010-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8516",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "42083",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherrie Lorraine Poujade, REGISTER NURSE
• Sarah Poulisse, MSW
• Ryan James Poulo, MD
• Avery C Poulsen
• Gwynna None Pound, COTA
• Irene G. Powch, PH.D.
• Powell Dental P.C.
• Powell Dental Specialties
• Powell Family Dental
• Powell Pharmacy, LLC

• Dentist in Portland, OR
• Providers in Portland, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.