NPIMap

Organization Active NPI

Mt. Scott Family Dental, LLC

  • Dentist
  • Happy Valley, OR
National Provider Identifier
1144237728
Registry record updated Jan 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D6577 Issued in OR
Legal business name
MT. SCOTT FAMILY DENTAL, LLC
Practice address
12100 SE Stevens Court
Suite 101
Happy Valley, OR 97086
Phone
(503) 353-9000
Fax
(503) 786-1873
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2013

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

Authorized official

Name
Dr. Ryan L. Donnelly, DMDNPI 1841346632
Title
Partner
Phone
(503) 353-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D6577 OR Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D8599 OR
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D6577 OR
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D8599 OR

Addresses

Primary practice location

12100 SE Stevens Court
Suite 101
Happy Valley, OR 97086

Mailing address

12100 SE Stevens Court
Suite 101
Happy Valley, OR 97086
Phone (503) 353-9000

National Provider Directory

National Provider Directory

Locations

12100 SE Stevens Ct
Ste 101
Portland, OR 97086
Phone (503) 353-9000

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359504000000",
    "number": "1144237728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12100 SE STEVENS COURT",
            "address_2": "SUITE 101",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "97086",
            "telephone_number": "503-353-9000",
            "fax_number": "503-786-1873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12100 SE STEVENS COURT",
            "address_2": "SUITE 101",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "97086",
            "telephone_number": "503-353-9000",
            "fax_number": "503-786-1873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. SCOTT FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2013-01-30",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "503-353-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6577",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8599",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6577",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8599",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Happy Valley, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; 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.