Individual provider Active NPI

Erda Carmel Pradel, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Salem, OR
National Provider Identifier
1386041358
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
D10975 Issued in OR
Practice address
3490 Lancaster Dr NE
Salem, OR 97305-1356
Phone
(855) 433-6825
NPI assigned
Nov 19, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 033975 CA
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D10975 OR Primary

Addresses

Primary practice location

3490 Lancaster Dr NE
Salem, OR 97305-1356

Mailing address

6950 NE Campus Way
Hillsboro, OR 97124-5611
Phone (855) 433-6825

Other identifiers 1

IdentifierTypeStateIssuer
D10975OtherOROREGON BOARD OF DENTISTRY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251029003952 OR Order and Referring Only - DentistPractitioner - Dentist 6305145442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33975CAMDSocial Worker
033975CAMDOral and Maxillofacial Surgery (Dentist)
D10975ORMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Willamette Dental Group Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1386041358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611",
            "telephone_number": "855-433-6825",
            "fax_number": "310-276-4186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3490 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051356",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRADEL",
        "first_name": "ERDA",
        "middle_name": "CARMEL",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-19",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "033975",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D10975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF DENTISTRY",
            "identifier": "D10975",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.