Active NPI
Brian Mitchell Wolfsehr, DMD
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1154331221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- OR5393
- Practice address
- 1433 NE 69TH
Portland, OR 97213-5301 - Phone
- (503) 254-2402
- Fax
- (503) 254-2402
- NPI assigned
- Aug 9, 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 | OR5393 | OR | Primary |
Addresses
Primary practice location
1433 NE 69TH
Portland, OR 97213-5301
Mailing address
1433 NE 69
Portland, OR 97213-5301
Phone (503) 254-2402
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 1, 2016 through Feb 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR5393 | OR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154331221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1433 NE 69",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972135301",
"telephone_number": "503-254-2402",
"fax_number": "503-254-2402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1433 NE 69TH",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972135301",
"telephone_number": "503-254-2402",
"fax_number": "503-254-2402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFSEHR",
"first_name": "BRIAN",
"middle_name": "MITCHELL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "OR5393",
"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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.