Main Street Dental

Primary specialty

DentistTaxonomy code 122300000X

License

D10345 Issued in OR

Legal business name

MAIN STREET DENTAL

Practice address

810 N Main Ave
Gresham, OR 97030-5538

Phone

(503) 665-8283

Fax

(503) 669-7263

NPI assigned

Jul 23, 2016

Organization subpart

No

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

Authorized official

Name

Kate Harmston

Title

Office Manager

Phone

(503) 665-8283

Specialties & licenses 1

Addresses

Other names 1

• Seth Monson DMD LLC Former legal business name

Locations

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

{
    "created_epoch": "1469232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469232000000",
    "number": "1124571369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 N MAIN AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305538",
            "telephone_number": "503-665-8283",
            "fax_number": "503-669-7263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N MAIN AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305538",
            "telephone_number": "503-665-8283",
            "fax_number": "503-669-7263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-23",
        "last_updated": "2016-07-23",
        "status": "A",
        "authorized_official_last_name": "HARMSTON",
        "authorized_official_first_name": "KATE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-665-8283"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seth Monson DMD LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kailea Jay Hart Mahler, SLP
• Fayyaz Mahmood, MD
• Kevin Mahon
• Madalena Thuy-Lan Mai
• Main Psychology Inc
• Joyce Maina
• Ryan George Maize
• Jaime Majure
• Oleg Maksimov, M.D.
• Sohil R Makwana, MD, MPH

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2016; 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.