Individual provider Active NPI

Juliana Panchura

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bend, OR
National Provider Identifier
1386863074
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
32603 Issued in CA
Practice address
569 NE Clay Ave
Bend, OR 97701-5158
Phone
(541) 771-1765
NPI assigned
Apr 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 32603 CA Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X D6633 OR

Addresses

Primary practice location

569 NE Clay Ave
Bend, OR 97701-5158

Mailing address

21651 Dale Rd
Bend, OR 97701-8819
Phone (541) 771-1765

Other practice location 1

1530 S Olive St
Los Angeles, CA 90015-3023
Phone (213) 746-1037

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address juliana.panchura.p1@direct.eisnerhealth.nextgenshare.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20220804003367 CA Order and Referring Only - DentistPractitioner - Dentist 7810379039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
32603CAMDMarriage & Family Therapist
D6633ORMDOrthodontics and Dentofacial Orthopedic Dentist

Interoperability endpoints

  • Direct secure messaging: juliana.panchura.1@28334.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1386863074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21651 DALE RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977018819",
            "telephone_number": "541-771-1765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "569 NE CLAY AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977015158",
            "telephone_number": "541-771-1765"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1530 S Olive St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900153023",
            "country_code": "US",
            "telephone_number": "213-746-1037",
            "fax_number": "213-746-9379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANCHURA",
        "first_name": "JULIANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "32603",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OR",
            "license": "D6633",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "juliana.panchura.p1@direct.eisnerhealth.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "NextGenShare, Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1530 S Olive St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900153023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.