Gresham DG LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GRESHAM DG LLC

Practice address

455 West Powell Blvd
Gresham, OR 97030

Phone

(503) 661-9696

NPI assigned

May 26, 2022

Last updated

May 26, 2022By 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

Ryan Smith, DDS

Title

Manager

Phone

(971) 708-9540

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1184362329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 WEST POWELL BLVD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 WEST POWELL BLVD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030",
            "telephone_number": "503-661-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRESHAM DG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "971-708-9540",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Gresham, OR
• Providers in Gresham, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.