Active NPI
Randy Heaton Reese, DDS
- Endodontics
- Portland, OR
National Provider Identifier
1285658922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D7045
- Practice address
- 10102 NE Glisan St
Portland, OR 97220-4456 - Phone
- (503) 257-5959
- NPI assigned
- Jul 26, 2006
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D7045 | OR | Primary |
Addresses
Primary practice location
10102 NE Glisan St
Portland, OR 97220-4456
Mailing address
10102 NE Glisan St
Portland, OR 97220-4456
Phone (503) 257-5959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285658922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10102 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972204456",
"telephone_number": "503-257-5959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10102 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972204456",
"telephone_number": "503-257-5959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REESE",
"first_name": "RANDY",
"middle_name": "HEATON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OR",
"license": "D7045",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.