NPIMap

Organization Active NPI

Mountainside General Dentistry

  • Dentist
  • Portland, OR
National Provider Identifier
1215104476
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D7895 Issued in OR
Legal business name
MOUNTAINSIDE GENERAL DENTISTRY
Practice address
3740 SE 122ND Ave
Portland, OR 97236-3405
Phone
(503) 762-2525
Fax
(503) 762-4872
NPI assigned
May 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Authorized official

Name
Dr. Lenore Supnet, D.M.D.
Title
Dentist
Phone
(503) 762-2525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D7895 OR Primary

Addresses

Primary practice location

3740 SE 122ND Ave
Portland, OR 97236-3405

Mailing address

3740 SE 122ND Ave
Portland, OR 97236-3405
Phone (503) 762-2525

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1215104476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3740 SE 122ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363405",
            "telephone_number": "503-762-2525",
            "fax_number": "503-762-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3740 SE 122ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363405",
            "telephone_number": "503-762-2525",
            "fax_number": "503-762-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSIDE GENERAL DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "SUPNET",
        "authorized_official_first_name": "LENORE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "503-762-2525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 15, 2008; 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.