Active NPI
Stephen John Persichetti, DDS
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1114932779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6239
- Practice address
- 1221 SW Yamhill Street
Suite 310
Portland, OR 97205 - Phone
- (503) 227-0958
- Fax
- (503) 222-4685
- NPI assigned
- Jul 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6239 | OR | Primary |
Addresses
Primary practice location
1221 SW Yamhill Street
Suite 310
Portland, OR 97205
Mailing address
1221 SW Yamhill Street
Suite 310
Portland, OR 97205
Phone (503) 227-0958
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Downtown Dental Associates LLP | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Portland, OR
- NPI 1538174289
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114932779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 SW YAMHILL STREET",
"address_2": "SUITE 310",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97205",
"telephone_number": "503-227-0958",
"fax_number": "503-222-4685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 SW YAMHILL STREET",
"address_2": "SUITE 310",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97205",
"telephone_number": "503-227-0958",
"fax_number": "503-222-4685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSICHETTI",
"first_name": "STEPHEN",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "6239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.