Robert Eugene Stafford, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4984 Issued in OR

Practice address

2020 SE 182ND Ave
Portland, OR 97233-5692

Phone

(503) 667-2400

Fax

(503) 492-9723

NPI assigned

May 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164630257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 SE 182ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335692",
            "telephone_number": "503-667-2400",
            "fax_number": "503-492-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 SE 182ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335692",
            "telephone_number": "503-667-2400",
            "fax_number": "503-492-9723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "ROBERT",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D4984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D4984",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irene Marie Stafford
• Kelly Stafford, BCBA
• Melanie Ailene Stafford, RD, LD
• Michelle D Stafford, D.D.S.
• Noah Williams Stafford
• Stag Crest Pathways LLC
• Brenda Stageberg
• Jean Marie Stager, M.S.W.
• Jennifer Marie Stager, BS, MMS, PA-C
• Jennifer Nicole Stahl, M.D.

• 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 Jul 8, 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.