Kristan Dyan Rodriguez, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11075 Issued in OR

Practice address

7615 SW Capitol Hwy
Portland, OR 97219-2436

Phone

(503) 244-3712

NPI assigned

Jul 31, 2017

Last updated

Aug 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kristan D Rodriguez DDS LLC

  • Dental Clinic/Center
  • Sherwood, OR
  • NPI 1265268494
  NPD Authorized official
• West End Dental

  dba James A Krippaehne DMD

  • General Practice Dentistry
  • Portland, OR
  • NPI 1164569638
  NPD (past)

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

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1366966533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31513 SW ORCHARD DR",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970705500",
            "telephone_number": "971-280-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7615 SW CAPITOL HWY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972192436",
            "telephone_number": "503-244-3712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "833 SW 11th Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972052117",
            "country_code": "US",
            "telephone_number": "503-224-7815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KRISTAN",
        "middle_name": "DYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-31",
        "last_updated": "2021-08-16",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "WILLSONVILLE",
            "affiliation": "N",
            "address_1": "7615 SW Capitol Hwy",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972192436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Grace Rodriguez, DACM, LAC
• Hector Manuel Rodriguez, D.O.
• Jennice Isabella Rodriguez
• Jessica Ruth Rodriguez, LMT
• Kevin Neftali Rodriguez
• Luis Felipe Rodriguez, MD
• Maria Garibay Rodriguez, M.S.W.
• Maria Isabel Rodriguez, MD
• Maria Isabel Rodriguez
• Mikaela Lea Rodriguez, MD

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.