Stacy Eden, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D10481 Issued in OR

Practice address

11820 SW King James PL
J10
Tigard, OR 97224-2480

Phone

(503) 616-5000

NPI assigned

Jun 15, 2010

Sex

Female

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1276560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1114248085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11820 SW KING JAMES PL",
            "address_2": "J10",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242480",
            "telephone_number": "503-616-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11820 SW KING JAMES PL",
            "address_2": "J10",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242480",
            "telephone_number": "503-616-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDEN",
        "first_name": "STACY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-15",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Eaton
• Thomas Marion Eberle, M.D.
• Vincent Eddi
• Richard Henry Edelson, M.D.
• Eden Wellness Center Corporation LLC
• Kevin Palmer Edenfield Jr.
• Kelly Elizabeth Edens, BS
• Oscar Birch Edwards-Hughes
• Nathan Lee Edwards
• Reba Edwards, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; 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.