Russell C Teasdale, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5751 Issued in OR

Practice address

1316 SW 13TH Avenue
Portland, OR 97201

Phone

(503) 235-0555

Fax

(503) 224-5726

NPI assigned

Jul 26, 2005

Last updated

Jun 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Dental Arts NW

  • Dentist
  • Portland, OR
  • NPI 1376991240
  NPD (past) Authorized official

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1083614689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 SW 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972013355",
            "telephone_number": "503-974-3829",
            "fax_number": "503-224-5726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 SW 13TH AVENUE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97201",
            "telephone_number": "503-235-0555",
            "fax_number": "503-224-5726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEASDALE",
        "first_name": "RUSSELL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "5751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teamworks International
• Abraham Teanso
• Tear of the Buddha LLC
• Teascape LLC
• Claire Teasdale, LMT
• Ashley Tecson
• Adrienne Tedesco, PHARMD
• Natalie Justine Tedford, MD
• Abel Tedros
• Jason Tee, PHARM D

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.