NPIMap

Organization Active NPI

Michelle C. Crocker, DMD, PC

  • Dentist
  • Portland, OR
National Provider Identifier
1235456153
Registry record updated May 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D8443 Issued in OR
Legal business name
MICHELLE C. CROCKER, DMD, PC
Practice address
11786 SW Barnes Rd Ste 320
Portland, OR 97225-5930
Phone
(503) 641-3550
NPI assigned
May 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2010

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

Authorized official

Name
Dr. Michelle C Crocker, DMDNPI 1295993541
Title
President
Phone
(503) 515-6092

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D8443 OR Primary

Addresses

Primary practice location

11786 SW Barnes Rd Ste 320
Portland, OR 97225-5930

Mailing address

13195 SW Shore Dr
Tigard, OR 97223-1683
Phone (503) 641-3550

National Provider Directory

National Provider Directory

Locations

11786 SW Barnes Rd
Ste 320
Portland, OR 97225
Phone (503) 641-3550

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1272758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272758400000",
    "number": "1235456153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 SW SHORE DR",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972231683",
            "telephone_number": "503-641-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11786 SW BARNES RD STE 320",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255930",
            "telephone_number": "503-641-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE C. CROCKER, DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-02",
        "last_updated": "2010-05-02",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-515-6092",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8443",
            "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 2, 2010; 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.