NPIMap

Organization Active NPI

Gateway Dental Clinic, PC

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1295031813
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D7355 Issued in OR
Legal business name
GATEWAY DENTAL CLINIC, PC
Practice address
10305 NE Halsey St
Portland, OR 97220-3954
Phone
(503) 252-0048
Fax
(503) 256-4041
NPI assigned
Jan 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Authorized official

Name
Dr. Josef Sedivy, DDSNPI 1326158544
Title
President
Phone
(503) 252-0048

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D7355 OR Primary

Addresses

Primary practice location

10305 NE Halsey St
Portland, OR 97220-3954

Mailing address

10305 NE Halsey St
Portland, OR 97220-3954
Phone (503) 252-0048

National Provider Directory

National Provider Directory

Locations

10305 NE Halsey St
Portland, OR 97220
Phone (503) 252-0048

Practitioners & affiliated clinicians

Practitioners 1

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": "1296172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296172800000",
    "number": "1295031813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10305 NE HALSEY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203954",
            "telephone_number": "503-252-0048",
            "fax_number": "503-256-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10305 NE HALSEY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972203954",
            "telephone_number": "503-252-0048",
            "fax_number": "503-256-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY DENTAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-28",
        "last_updated": "2011-01-28",
        "status": "A",
        "authorized_official_last_name": "SEDIVY",
        "authorized_official_first_name": "JOSEF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-252-0048",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7355",
            "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 Jan 28, 2011; 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.