Active NPI
Grant Alexander, DMD
- General Practice Dentistry
- Clackamas, OR
National Provider Identifier
1124756788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D11680
- Practice address
- 16144 SE Happy Valley Town Center Dr
Clackamas, OR 97086-4257 - Phone
- (503) 667-2400
- NPI assigned
- Aug 11, 2022
- 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 | D11680 | OR | Primary |
Addresses
Primary practice location
16144 SE Happy Valley Town Center Dr
Clackamas, OR 97086-4257
Mailing address
17130 SE Stoneybrook CT
Clackamas, OR 97015-7765
Phone (503) 807-5580
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11680 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VDW, LLC | General Practice | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660176000000",
"number": "1124756788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17130 SE STONEYBROOK CT",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970157765",
"telephone_number": "503-807-5580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16144 SE HAPPY VALLEY TOWN CENTER DR",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970864257",
"telephone_number": "503-667-2400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALEXANDER",
"first_name": "GRANT",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-11",
"last_updated": "2022-08-11",
"certification_date": "2022-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D11680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.