Willamette Dental

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

H5284 Issued in OR

Legal business name

WILLAMETTE DENTAL

Practice address

4925 SW Griffith Dr
Beaverton, OR 97005

Phone

(971) 222-8003

NPI assigned

Nov 21, 2013

Organization subpart

No

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

Authorized official

Name

Loan Thanh Phan

Title

Dental Hygiene

Phone

(971) 222-8003

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1384992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384992000000",
    "number": "1356771786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16213 SW BRAY LN",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "97224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 SW GRIFFITH DR",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97005",
            "telephone_number": "971-222-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-21",
        "last_updated": "2013-11-21",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "LOAN",
        "authorized_official_middle_name": "THANH",
        "authorized_official_title_or_position": "DENTAL HYGIENE",
        "authorized_official_telephone_number": "971-222-8003"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OR",
            "license": "H5284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerald Stanley Wilk Jr.
• Ashley Wilkins, LCSW
• Denise Wilkinson, O.D.
• Willamette Dental
• Willamette Dental
• Willamette Dental Group
• Elaine Karen Willbanks, RN
• Jonathan Willden, MA, LPC INTERN
• Willettedental
• Alice Maureen Williams, LPC, LMFT

• Preferred Provider Organization in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Preferred Provider Organization in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; 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.