Roots Dental Stark LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D9728 Issued in OR

Legal business name

ROOTS DENTAL STARK LLC

Practice address

16338 SE Stark St
Portland, OR 97233-3958

Phone

(971) 294-1399

NPI assigned

Aug 22, 2018

Organization subpart

No

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

Authorized official

Name

Ryan Smith, DDS

Title

Manager

Phone

(503) 912-2600

Specialties & licenses 1

Addresses

Other names 1

• Roots Dental Doing business as

Locations

Practitioners 1

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

• Ryan Douglas McCormick, DMD

  • Dentist
  • Portland, OR
  • NPI 1073162699
  NPD (past)

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1063993749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16338 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972333958",
            "telephone_number": "503-912-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16338 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972333958",
            "telephone_number": "971-294-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS DENTAL STARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-22",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "503-912-2600",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "D9728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roots Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Roots Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rooted PDX LLC
• Roots and Wings Therapy LLC
• Roots Dental Broadway LLC
• Roots Dental GP LLC
• Roots Dental LLC
• Roots Foundational Counseling LLC
• Roots Health Clinic LLC
• Roots Orthodontics LLC
• Roots Physical Therapy LLC
• Roots Therapy NW LLC

• Dental Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; 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.