Lifesmile Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7362 Issued in OR

Legal business name

LIFESMILE DENTAL GROUP

Practice address

13305 NW Cornell Rd
Suite a
Portland, OR 97229-5817

Phone

(503) 644-5433

Fax

(503) 633-5436

NPI assigned

Sep 15, 2007

Last updated

Sep 15, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Hicks, DMDNPI 1922168335

Title

President

Phone

(503) 644-5433

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Randal Hicks, DMD

  • General Practice Dentistry
  • Portland, OR
  • NPI 1922168335
  NPD (past) Authorized official

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

{
    "created_epoch": "1189814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189814400000",
    "number": "1144416959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13305 NW CORNELL RD",
            "address_2": "SUITE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295817",
            "telephone_number": "503-644-5433",
            "fax_number": "503-633-5436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13305 NW CORNELL RD",
            "address_2": "SUITE A",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295817",
            "telephone_number": "503-644-5433",
            "fax_number": "503-633-5436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESMILE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-15",
        "last_updated": "2007-09-15",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-644-5433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Life Restoration Missions (Restorative Journey)
• Life Works Northwest
• Lifekey Counseling
• Lifelong Learning LLC (Lifelong learning)
• Lifelong Wellness Center, LLC
• Lifestyles Physical Therapy, PC
• Lifetime Optimization, Inc.
• Lifeweighs (LifeWeighs LLC)
• Lifeworks Northwest
• Lifeworks Northwest

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.

Verify at the official NPI Registry.