NPIMap

Organization Active NPI

Bridgeport Dental LLC

  • Dental Clinic/Center
  • Tigard, OR
National Provider Identifier
1093086415
Registry record updated Jan 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
BRIDGEPORT DENTAL LLC
Practice address
18035 SW Lower Boones Ferry Rd
Tigard, OR 97224-7228
Phone
(503) 906-8600
Fax
(503) 716-4607
NPI assigned
Jan 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2012

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

Authorized official

Name
Geroge Kang, DDS
Title
DDS
Phone
(503) 906-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X OR Primary

Addresses

Primary practice location

18035 SW Lower Boones Ferry Rd
Tigard, OR 97224-7228

Mailing address

18035 SW Lower Boones Ferry Rd
Tigard, OR 97224-7228
Phone (503) 906-8600

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1093086415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18035 SW LOWER BOONES FERRY RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247228",
            "telephone_number": "503-906-8600",
            "fax_number": "503-716-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18035 SW LOWER BOONES FERRY RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247228",
            "telephone_number": "503-906-8600",
            "fax_number": "503-716-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-17",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "KANG",
        "authorized_official_first_name": "GEROGE",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "503-906-8600",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2012; 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.