Active NPI
Matthew Park, DMD
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1265682215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D9187
- Practice address
- 680 NW Murray Blvd
Portland, OR 97229-5872 - Phone
- (503) 646-6300
- NPI assigned
- Sep 26, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D9187 | OR | Primary |
Addresses
Primary practice location
680 NW Murray Blvd
Portland, OR 97229-5872
Mailing address
680 NW Murray Blvd
Portland, OR 97229-5872
Phone (503) 646-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150622001906 | OR | Order and Referring Only - Oral Surgery | 1456662121 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9187 | OR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1265682215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 NW MURRAY BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972295872",
"telephone_number": "503-646-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 NW MURRAY BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972295872",
"telephone_number": "503-646-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MATTHEW",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-26",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D9187",
"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 Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.