Signature Oregon Dental Partners PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SIGNATURE OREGON DENTAL PARTNERS PC

Doing business as

Broadway Family Dentistry
Horacek Dental
On Q Dentistry1 more in Other names

Practice address

11815 SW King James PL Ste 10
Tigard, OR 97224-2479

Phone

(503) 433-8256

NPI assigned

Oct 1, 2019

Organization subpart

Yes

Parent organization

SIGNATURE DENTAL PARTNERS LLCAs reported in NPPES

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

Authorized official

Name

Melody Bennion

Title

Director of Integrations

Phone

(480) 234-8490

Specialties & licenses 1

Addresses

Other names 4

• Broadway Family Dentistry Doing business as
• Horacek Dental Doing business as
• On Q Dentistry Doing business as
• Total Health Dental Care Doing business as

Part of

Signature Dental Partners LLC

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chet L. Jenkins, D.D.S.

  • Dentist
  • Mesa, AZ
  • NPI 1750502456
  NPD
• Kimberly Ann Glover, RDH

  • Dental Hygienist
  • Milton Freewater, OR
  • NPI 1427828722
  NPD (past)
• Chenoa Marie Martin, RDH

  • Dental Hygienist
  • Portland, OR
  • NPI 1225317241
  NPD (past)
• Norman Dean Saager

  • Public Health Dentistry
  • Milton Freewater, OR
  • NPI 1104948579
  NPD (past)

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

{
    "created_epoch": "1569888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626739200000",
    "number": "1114568029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N 44TH ST STE 290",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850087622",
            "telephone_number": "480-626-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11815 SW KING JAMES PL STE 10",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242479",
            "telephone_number": "503-433-8256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5528 SE Powell Blvd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972062956",
            "country_code": "US",
            "telephone_number": "503-788-1008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9211 SE Division St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972661452",
            "country_code": "US",
            "telephone_number": "503-254-2068",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "508 E Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Milton Freewater",
            "state": "OR",
            "postal_code": "978621315",
            "country_code": "US",
            "telephone_number": "541-938-3363",
            "fax_number": "541-938-3912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SIGNATURE OREGON DENTAL PARTNERS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIGNATURE DENTAL PARTNERS LLC",
        "enumeration_date": "2019-10-01",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A",
        "authorized_official_last_name": "BENNION",
        "authorized_official_first_name": "MELODY",
        "authorized_official_title_or_position": "DIRECTOR OF INTEGRATIONS",
        "authorized_official_telephone_number": "480-234-8490"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Horacek Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Horacek Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "On Q Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Total Health Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shana Sierra, CADC II
• Ericka Siewert, BS, RDH, EPDH
• Andrea Siferd
• Bradley E Sigafoose, LPC
• Signature Hospice Portland, LLC (Signature Healthcare at Home)
• Valerie Siira, M.ED.
• Malia Palealofa Silia
• David G Silvestre, MD
• Tanner Lee Silvis
• Ashley Silvius

• Dental Clinic/Center in Tigard, OR
• Providers in Tigard, 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 20, 2021; 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.