Willamette Dental

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

H5456 Issued in OR

Legal business name

WILLAMETTE DENTAL

Practice address

4925 SW Griffith Dr
Beaverton, OR 97005-2923

Phone

(855) 433-6825

NPI assigned

Mar 28, 2014

Organization subpart

No

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

Authorized official

Name

Manimone Phanthamath, RDH

Title

Dental Hygienist

Phone

(503) 715-7876

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395964800000",
    "number": "1194143065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 SE 194TH PL",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986078664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 SW GRIFFITH DR",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052923",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2014-03-28",
        "status": "A",
        "authorized_official_last_name": "PHANTHAMATH",
        "authorized_official_first_name": "MANIMONE",
        "authorized_official_title_or_position": "DENTAL HYGIENIST",
        "authorized_official_telephone_number": "503-715-7876",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "OR",
            "license": "H5456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wildwood Psychiatric Resource Center
• Suzanne Wilhour
• Gerald Stanley Wilk Jr.
• Ashley Wilkins, LCSW
• Denise Wilkinson, O.D.
• Willamette Dental
• Willamette Dental
• Willamette Dental Group
• Elaine Karen Willbanks, RN
• Jonathan Willden, MA, LPC INTERN

• Health Maintenance Organization in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Health Maintenance Organization in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; 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.