Revolution Dental Implant Center

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

REVOLUTION DENTAL IMPLANT CENTER

Practice address

19017 Beavercreek Rd
Oregon City, OR 97045-9537

Phone

(503) 777-3333

NPI assigned

Feb 21, 2023

Organization subpart

No

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

Authorized official

Name

Bradley Houtman

Title

Operations Manager

Phone

(503) 777-3333

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taylor James Mullaney, DMD

  • Dentist
  • Oregon City, OR
  • NPI 1447924782
  NPD

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1194423988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19017 BEAVERCREEK RD",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970459537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19017 BEAVERCREEK RD",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970459537",
            "telephone_number": "503-777-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION DENTAL IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-21",
        "last_updated": "2023-03-07",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "HOUTMAN",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "503-777-3333"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D9000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Matthew Resk, M.D.
• Hayden Resnick, OTD OTR/L
• Marla Sue Resnick, M.S.
• Renata Retter, DC
• Douglas Brian Retzlaff, DMD, PC
• Hannah Cross Rhinehart, CNM
• Elizabeth Dawn Rhoades, LMT
• Meghan M. Rich, MA, LPCC, NCC
• Amber Richards, CRM II, PWS, THW
• Samantha Jo Richardson

• Dental Clinic/Center in Oregon City, OR
• Providers in Oregon City, 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 Mar 7, 2023; 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.