NPIMap

Organization Active NPI

Summit Oregon LLC

Doing business as Summit Oral Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Portland, OR
National Provider Identifier
1205664844
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
SUMMIT OREGON LLC
Doing business as
Summit Oral Surgery
Practice address
3332 N Lombard St Ste C
Portland, OR 97217-1258
Phone
(503) 548-2006
Fax
(503) 548-2012
NPI assigned
Jul 24, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Authorized official

Name
Dr. Prashant Charugundla, DDSNPI 1700317401
Title
Oral & Maxillofacial Surgeon
Phone
(503) 548-2006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

3332 N Lombard St Ste C
Portland, OR 97217-1258

Mailing address

3332 N Lombard St Ste C
Portland, OR 97217-1258
Phone (503) 548-2006

Other names 1

  • Summit Oral Surgery Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1721779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775433600000",
    "number": "1205664844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3332 N LOMBARD ST STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972171258",
            "telephone_number": "503-548-2006",
            "fax_number": "503-548-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3332 N LOMBARD ST STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972171258",
            "telephone_number": "503-548-2006",
            "fax_number": "503-548-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT OREGON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-24",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A",
        "authorized_official_last_name": "CHARUGUNDLA",
        "authorized_official_first_name": "PRASHANT",
        "authorized_official_title_or_position": "ORAL & MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "503-548-2006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summit Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2026; 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.