NPIMap

Organization Active NPI

Tigard Family Dental, PC

  • General Practice Dentistry
  • Tigard, OR
National Provider Identifier
1205135118
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D7467 Issued in OR
Legal business name
TIGARD FAMILY DENTAL, PC
Practice address
11820 SW King James PL Ste 20
Tigard, OR 97224-2481
Phone
(503) 620-2020
NPI assigned
Mar 17, 2011
Last updated
Nov 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Rebecca Ann Martinez
Title
Office Manager
Phone
(503) 968-2901

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D7467 OR Primary

Addresses

Primary practice location

11820 SW King James PL Ste 20
Tigard, OR 97224-2481

Mailing address

11820 SW King James PL Ste 20
Tigard, OR 97224-2481
Phone (503) 620-2020

National Provider Directory

National Provider Directory
Tax ID family
Oregon Mobile Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11820 SW King James Pl
Ste 20
Tigard, OR 97224
Phone (503) 620-2020

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1205135118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11820 SW KING JAMES PL STE 20",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242481",
            "telephone_number": "503-620-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11820 SW KING JAMES PL STE 20",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242481",
            "telephone_number": "503-620-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIGARD FAMILY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-968-2901"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.