BD-Gresham, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BD-GRESHAM, LLC

Doing business as

Brookside Dental-Gresham

Practice address

1700 NW Civic Dr Ste 320
Gresham, OR 97030-3774

Phone

(503) 666-2515

NPI assigned

Jul 17, 2023

Last updated

Jul 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debbie Lopez

Title

Regional Manager

Phone

(503) 914-8221

Specialties & licenses 1

Addresses

Other names 1

• Brookside Dental-Gresham Doing business as

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

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1083393920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 NW CIVIC DR STE 320",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303774",
            "telephone_number": "503-666-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NW CIVIC DR STE 320",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303774",
            "telephone_number": "503-666-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BD-GRESHAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "503-914-8221"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Dental-Gresham",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexander Bautista
• Gina Marjorie Bawden, PAC
• Bonita Baxter
• Wylie Allan Bay, MSW
• Albert Bazurto, LPC
• Nicholas Beach, D.O.
• Emily Beasley
• Kristen Brooke Beck, MS, LPC
• Deborah Ann Beckman, RDH
• Thalia Elizabeth Begun, QMHA

• Dental Clinic/Center in Gresham, OR
• Providers in Gresham, 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 Jul 17, 2023; 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.