NPIMap

Organization Active NPI

Estacada Family Dental, LLC

  • General Practice Dentistry
  • Estacada, OR
National Provider Identifier
1366059768
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ESTACADA FAMILY DENTAL, LLC
Practice address
630 N Broadway St
Estacada, OR 97023-8584
Phone
(503) 630-4218
NPI assigned
Sep 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Authorized official

Name
Cornelius Gehred, DDSNPI 1033259734
Title
President
Phone
(503) 630-4218

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 Primary

Addresses

Primary practice location

630 N Broadway St
Estacada, OR 97023-8584

Mailing address

PO Box 929
Estacada, OR 97023-0929

National Provider Directory

National Provider Directory

Locations

630 N Broadway St
Estacada, OR 97023
Phone (503) 630-4218

Practitioners & affiliated clinicians

Practitioners 4

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": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1366059768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 929",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "970230929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N BROADWAY ST",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "970238584",
            "telephone_number": "503-630-4218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTACADA FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-29",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "GEHRED",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-630-4218",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Estacada, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.