Jeremy E Archibald, DDS
Individual provider Active NPI Dentist · Gresham, OR
NPI 1336352368 · NPPES record last updated Mar 31, 2016
Key facts
- NPI
- 1336352368
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D8266 (OR)
- Practice address
- 742 NE Division St Ste 101
Gresham, OR 97030-3979 - Phone
- (503) 665-7017
- Fax
- (503) 665-5135
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160322002802 | OR | Order and Referring Only - Dentist |
4789981515 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D8266 | OR | Yes |
Addresses
Primary practice location
742 NE Division St Ste 101
Gresham, OR 97030-3979
Mailing address
742 NE Division St Ste 101
Gresham, OR 97030-3979
Phone (503) 665-7017
Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.