Active NPI
Dennis Gene Perala, DMD
- Periodontics
- Beaverton, OR
National Provider Identifier
1174668156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- D6715
- Practice address
- 8070 SW Hall Blvd
#200
Beaverton, OR 97008-6419 - Phone
- (503) 644-1110
- Fax
- (503) 641-6431
- NPI assigned
- Feb 20, 2007
- Last updated
- Feb 14, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | D6715 | OR | Primary |
| Periodontics | 1223P0300X | D8616 | WA |
Addresses
Primary practice location
8070 SW Hall Blvd
#200
Beaverton, OR 97008-6419
Mailing address
8070 SW Hall Blvd
#200
Beaverton, OR 97008-6419
Phone (503) 644-1110
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 134580 | Medicaid | OR | |
| 5036165 | Medicaid | WA | |
| 8932837 | Other | WA | CRIME VICTIMS |
| 0141506 | Other | WA | LABOR & INDUSTRIES |
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 Dec 21, 2017 through Dec 21, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D6715 | OR | MD | Periodontist |
| D8616 | WA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hadi Nouredine DMD | Past | Accepting new patients | |
| Wendel Family Dental Centre PS | Periodontics | Past | Accepting new patients |
| Jacob D Groom DMD PLLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Hiddenbrook Dental
- General Practice Dentistry
- Vancouver, WA
- NPI 1699560300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360800000000",
"number": "1174668156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8070 SW HALL BLVD",
"address_2": "#200",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970086419",
"telephone_number": "503-644-1110",
"fax_number": "503-641-6431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8070 SW HALL BLVD",
"address_2": "#200",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970086419",
"telephone_number": "503-644-1110",
"fax_number": "503-641-6431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERALA",
"first_name": "DENNIS",
"middle_name": "GENE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-20",
"last_updated": "2013-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OR",
"license": "D6715",
"primary": true
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WA",
"license": "D8616",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "134580",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5036165",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8932837",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "0141506",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; 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.