Susan Lai, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D11824 Issued in OR

Practice address

30040 SW Boones Ferry Rd Ste 20
Wilsonville, OR 97070-8910

Phone

(503) 682-4500

NPI assigned

May 22, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Wilsonville Smiles PC

  • General Practice Dentistry
  • Wilsonville, OR
  • NPI 1346516192
  NPD (past)

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1104518968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12676 SW 133RD AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972234714",
            "telephone_number": "503-927-8086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30040 SW BOONES FERRY RD STE 20",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970708910",
            "telephone_number": "503-682-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 S Moody Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "503-494-8867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAI",
        "first_name": "SUSAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine J Spencer
• Jason Ryan Kummerman, PHARMD
• Judith Ann Kuntz, MA, LMFT
• Alyssa Marie Kurth, D.C.
• Laura M La Joie, DC
• Brittany Lakey
• Cara Elizabeth Lakin
• William John Lane, OTR/L
• Clara Feist Lang, RPH
• Cheyenne Langjahr, RDH

• Dentist in Wilsonville, OR
• Providers in Wilsonville, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.

Verify at the official NPI Registry.