Active NPI
William Marra, DMD
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1083022040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D10073
- Practice address
- 2520 E Burnside St
Portland, OR 97214-1754 - Phone
- (503) 233-3622
- NPI assigned
- Jul 23, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D10073 | OR | Primary |
Addresses
Primary practice location
2520 E Burnside St
Portland, OR 97214-1754
Mailing address
4980 SW Landing Dr Apt 302
Portland, OR 97239-5967
Phone (412) 855-1107
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160616001558 | OR | Order and Referring Only - Dentist | 0143511451 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Laurelhurst Dentistry LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Portland, OR
- NPI 1992982938
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406073600000",
"number": "1083022040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4980 SW LANDING DR APT 302",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972395967",
"telephone_number": "412-855-1107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2520 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141754",
"telephone_number": "503-233-3622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARRA",
"first_name": "WILLIAM",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-23",
"last_updated": "2014-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D10073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.